Application value of Calot triangle hollowing out maneuver in laparoscopic cholecystectomy

Objective:To investigate the application value of Calot triangle hollowingout maneuver in laparoscopic cholecystectomy (LC) for preventing bile duct injury.
Methods:The retrospective crosssectional study was conducted. The clinical data of 537 patients who underwent LC in the Dexing People′s Hospital between January 2011 and December 2015 were collected. The tissues in Calot triangle were hollowed out, and cystic ducts were cut off and then gall bladders were resected. Observation indicators: (1) operation situations: anatomy of the Calot triangle and operation time; (2) postoperative recovery situations: postoperative complications and bile duct injury; (3) followup situation. The followup using outpatient examination and telephone interview was performed to detect the survival of patients and occurrence of cholangitis up to May 2016.
Results:(1) Operation situations: of 537 patients with LC, anatomical relation among cystic duct, common hepatic duct and common bile duct (threeduct relation for short) could be seen in 165 patients without dissection, and threeduct relation cannot be seen in other 372 patients. Of 372 patients, 16 were operated on with the gallbladder open due to the difficult dissection of Calot triangle, 7 were converted to open surgery due to local severe adhesion and unclear structure, 1 was converted to open surgery due to intraoperative varices induced bleeding in Calot triangle, and other 348 patients underwent successful LC using Calot triangle hollowingout maneuver. Operation time was 15-190 minutes, with an average time of 28 minutes. (2) Postoperative situations: 2 patients were complicated with biliary colic pain, showing stones in the distal common bile duct via magnetic resonance imaging scans, and then received endoscopic sphincterotomy (EST); 3 had subxyphoid puncture hole infection, 1 had a small amount of postoperative bleeding due to hepatocirrhosis, 3 had pulmonary infection, and they were improved by symptomatic treatment; 1 had chylous fistula and were improved through drainage and low fat diet intake for 1 week; 2 with mild bile leakage was improved through peritoneal drainage. No bile duct injury was detected. (3) Followup situation: 348 patients were followed up for 12-18 months, with a median time of 16 months. During the followup, 348 patients with followup had survival without manifestation of cholangitis.
Conclusion:Calot triangle hollowingout maneuver could effectively prevent bile duct injury in LC.