Value of gallbladder-preserving partial cholecystectomy in treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis

Objective To investigate the value of laparoscopic gallbladder-preserving partial cholecystectomy in the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis. Methods A total of 18 patients with abnormal gallbladder morphology complicated by sand-like calculous cholecystitis who underwent laparoscopic and choledochoscopic partial cholecystectomy in Dalian Friendship Hospital from July 2010 to January 2014 were enrolled. All the patients had abnormal gallbladder morphology manifested as folded gallbladder or adenomyosis,and the lesions were located in the distal end of the gallbladder. Before the surgery,gallbladder contraction test was performed for the diseased part and the normal part of the gallbladder to be preserved. During the surgery,choledochoscopy showed an unobstructed cystic duct and good elasticity in the gallbladder wall,and there was no marked chronic inflammation. After the diseased part of the gallbladder was removed,4-0 absorbable suture was used for two-layer consecutive suture of the gallbladder. The t-test was used for comparison of continuous data between groups. Results All the patients underwent the surgery successfully. The mean time of operation was 98. 0± 9. 0 minutes,and the mean time to first flatus was 22. 8 ± 2. 5 hours. The patients were able to get out of the bed and drink water at 6 hours after surgery and to have meals at 24 hours after surgery. They fully recovered and were discharged at 5-7 days after surgery,and no patient experienced the complications such as bile leakage. The patients were followed up for 6-80 months; the patients' preoperative clinical symptoms disappeared,and there was no recurrence of calculi. At 6-12 months after surgery,the patients experienced compensated cholecystectasis,and there was a significant increase in the mean volume of the gallbladder after surgery( 30. 29 ± 4. 23 cm3 vs 21. 72 ± 4. 34 cm3,t =-13.00,P < 0. 001). There was a significant increase in mean gallbladder contraction after surgery( 56. 9% ± 10. 9% vs 48. 5% ± 12. 7%,t =-6. 11,P < 0. 001). Conclusion In the treatment of abnormal gallbladder morphology complicated by sand-like calculous cholecystitis,laparoscopic and choledochoscopic gallbladder-preserving partial cholecystectomy plays an important role in protecting the gallbladder and its function.It may become a new surgical procedure in gallbladder-preserving surgical treatment when its indications are strictly followed.