Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

Jeong, In Oh; Kim, Jang Yong; Choe, Yun Mee; Choi, Sun Keun; Heo, Yoon Seok; Lee, Keon Young; Kim, Sei Joong; Cho, Young Up; Ahn, Seung-Ik; Hong, Kwang Pyo; Kim, Kyung Rae; Shin, Sangmun

doi:10.14701/kjhbps.2011.15.4.225

Cited by 10 publications

(21 citation statements)

References 17 publications

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“…Difficult dissection can cause liver injury and troublesome bleeding. Compared to SLC, LSC and LSCA had significantly less blood loss in difficult cholecystectomies [15161718]. With the use of ultrasonic scissors, it becomes easier and faster to transect the anterior wall of the GB without bleeding.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

et al. 2016

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PurposeLaparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA).MethodsWe retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA.ResultsA total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients.ConclusionLSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

et al. 2016

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“…Various techniques have been reported in the literature to avoid BDI: obtaining a critical view of safety (CVS) [38], identifying Rouvière's sulcus [39], performing intraoperative cholangiogram (IOC) [40], performing intraoperative fluorescent cholangiogram using indocyanine green [41], and converting to an open procedure [7].…”

Section: Discussionmentioning

confidence: 99%

“…6 Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy. 7 Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Cannizzaro Hospital, University of Catania, Via Messina 829, 95126 Catania, Italy.…”

Section: Abbreviationsmentioning

confidence: 99%

“…One of the "rescue" procedures to complete the surgery safely (both for the surgeons and patients) is subtotal cholecystectomy (STC). Open [4][5][6] and laparoscopic [7][8][9] subtotal cholecystectomy have been reported. For many surgeons, this is considered a bail out technique [10,11], and the timing of decision making is crucial to avoid catastrophic complications.…”

Section: Introductionmentioning

confidence: 99%

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Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Toro¹,

Teodoro²,

Khan

et al. 2021

World J Emerg Surg

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Background Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. Patients and methods A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Results Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. Conclusion In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

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“…19 No def ined risk factors were repor ted for subtotal cholecystectomy, though there have been associations with high C-reactive protein (CRP) and Tokyo grading. 20 Shingu et al attempted to create a predictive score for LSC which consisted of preoperative CRP elevation, wall thickened GB, atrophic GB, pericholecystic abscess, and structure of the hepatic bile duct. Mean of the predictive score in LSC was 8.2, and ideal cutoff point for score was 8; specificity and sensitivity toward LSC was 76.0% and 77.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Frequency, Complications, and Predictive Factors for Performing Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit: A Comparative Cohort Study

Farrugia¹,

Ravichandran²,

Ali³

et al. 2019

World Journal of Laparoscopic Surgery With DVD

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Aims: Laparoscopic subtotal cholecystectomies (LSCs) are occasionally performed for difficult gallbladder (GB) surgery. The aim of this study is to determine the rate, complications, and factors predictive of performing LSC in a hepatobiliary (HPB) unit, in comparison to patients who have undergone a conventional operation. Materials and methods: A 5-year retrospective review of laparoscopic cholecystectomies (LCs) was performed by HPB team at a tertiary center. Demographic, operative, and postoperative data were identified. A randomized group (generated using online randomization software Research Randomizer®) of LC patients was identified from the study cohort, who had the same data recorded for comparison. Significance level was set at p < 0.05 when comparing the two groups of LC and LSC. Results: A total of 1,613 patients underwent LC, of which, 102 (6.3%) underwent LSC. The complication rate was 12.7% in the LSC group, mainly consisting of bile leak (3.9%) and collection requiring drainage (0.98%). The LC group had a 4.9% complication rate, of which, one bile leak was reported, i.e., 1 (0.98%). The length of stay was significantly longer in the LSC group (2 days vs 0 days in the LC group), and this group also had a slightly higher readmission rate (8.8% vs 3.92%). Laparoscopic subtotal cholecystectomy was found to be more likely in patients with previous cholecystitis, thickened GB wall on imaging and previous endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure and the above characteristics may be used to potentially predict who is more likely to undergo LSC. This may aid in the consenting process and also help to create a score that predicts the probability of undergoing LSC.

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Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

Cited by 10 publications

References 17 publications

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Frequency, Complications, and Predictive Factors for Performing Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit: A Comparative Cohort Study

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