Transcylindrical gas-free cholecystectomy for the treatment of cholelithiasis, cholecystitis, and choledocholithiasis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the standard for treatment of uncomplicated cholecystolithiasis. However, in cases of cholecystitis or cholecysto-choledocholithiasis, technical and skill requirements may make questionable the convenience of laparoscopy. Transcylindrical cholecystectomy (TC) is a modified minilaparotomy, performed gas-free through a single cylinder 3.8 cm in diameter and 10.0 cm in length. Our study objective has been to assess the efficacy and potential advantages of TC in the treatment of cholelithiasis, cholecystitis, and cholecholithiasis through an efficacy, prospective, and longitudinal study.

METHOD: TC was carried out in 364 consecutive patients including 78 acute cholecystitis, 37 acute biliary pancreatitis, and 48 suspected choledocholithiasis. Transcystic cholangiography was selectively attempted in 74 patients (20.3%) and successfully obtained in all but one patient. Twenty-six patients (7.1%) underwent transcylindrical common duct exploration (and calculi removal) through a choledochotomy.

RESULTS: Operation was converted into subcostal laparotomy in other 23 patients (5.9%). In our series, there were no injuries to the main bile ducts or hemorrhagic accidents. Operating times in minutes (SD) were (i) "simple cholecystectomy" without cholangiography n = 237: 43.5 (13.3), with cholangiography n = 30: 64.2 (20.7), (ii) "cholecystitis" n = 78: 66.2 (28.7), and (iii) "choledocholithiasis" n = 26: 117.0 (24.6). Postoperative complications for the respective patients in groups i, ii, and iii were (a) wound infection: 5 (1.9%), 0 and 0; (b) bile leaks: 2 (0.75%; one causing death), 2 (0.75%) and 0; (c) reoperation for bleeding: 1 (0.4%), 0 and 1 (3.8%); and (d) residual stones in the main bile ducts: 0, 0 and 1 (3.8%).

CONCLUSION: TC has been proved to be applicable, efficient, and safe for the treatment of cholelithiasis and its complications.