Postoperatively, the clinical behavior of these patients is the same as for
all patients undergoing a minimally invasive procedure. The next day they
usually are on a regular diet and ambulatory. Unless they have associated
medical problems, most patients can be discharged within 48 hours. They are
discharged with Blake drains in place. Interestingly, some patients will
have a bile leak-drainage noticeable on postoperative day one, and others
will not. This is most likely secondary to a blocked cystic duct secondary
to an impacted gallstone. Nonetheless, these drains are to remain in place
for two weeks or until they cease to drain.
Bile Leak-Drainage: Most
patients will have significant bile drainage, as this procedure effectively
creates a controlled bilio-cutaneous fistula. The average or mean bilious
drainage is two days. The longest recorded drainage has been 21 days. As a
rule, in the absence of a distal common bile duct obstruction, all bilious
drainage or leaks will cease within three weeks.
This procedure does not allow the performance of an intra-operative
cholangiogram or the placement of a cystic duct cannula. One patient was
found postoperatively to have a retained common bile duct stone requiring
an Endoscopic Retrograde Cholangiography and Papillotomy. Another patient
developed a sub-phrenic abscess and eventually required a laparotomy.
Impact of Anterior-subtotal
Laparoscopic Cholecystectomy On the Conversion Rate:
Prior to introducing this procedure, most conversions occurred in patients
with acute, severe, and gangrenous cholecystitis. This procedure effectively
decreased our conversion rate as soon as it was introduced. Actually, since
its introduction, 896 LapCholes were done with only one conversion. This
reduction in the conversion rate is probably the most significant advantage
of this technique.