Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Abstract

Background Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. Methods Fifty‐seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. Results Thirty‐three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29‐86). All patients had at least one episode of cholecystitis. Forty‐seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow‐up of 49 months (range: 13‐98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. Conclusions Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases.

The effect of surgical strategy in difficult cholecystectomy cases on postoperative complications outcome: a value-based healthcare comparative study

“…The subtotal cholecystectomy has gained popularity in the last few years in difficult LC cases and is promoted to safely end a procedure laparoscopically with minimal risk of bile duct injury [19,20]. However, in this comparative study All baseline variables were tested.…”

Falciform Patch for Laparoscopic Subtotal Cholecystectomy to Decrease Biliary Fistulas

“…approach is associated with a high postoperative bile leak rate requiring additional interventions. 4,7 We report a novel technique to reduce the rate of bile leak after LSC-F that can be utilized by most general and acute care surgeons. Although there are no previous reports of utilizing the falciform ligament for LSC, a group from Japan described the use of ''omental plugging technique'' using a devascularized segment of omentum with a decrease in bile leak.…”

“…3 Another main advantage of the FP technique is potentially obliterating the remnant gallbladder space rather than reconstituting and forming a neo-gallbladder with risk of recurrent cholelithiasis and remnant cholecystitis requiring a complex reoperation. 7…”

“…4,5 However, LSC-F is associated with high rates of postoperative bile leak with described range between 10.8% and 40%. [4][5][6][7] Although some postoperative bile leaks resolve with drainage alone, ERCP with or without biliary stent insertions and sphincterotomy are often required. 2,4,7 ERCP is associated with additional health care cost, time, and complications such as pancreatitis, cholangitis, hemorrhage, and perforation.…”

“…[4][5][6][7] Although some postoperative bile leaks resolve with drainage alone, ERCP with or without biliary stent insertions and sphincterotomy are often required. 2,4,7 ERCP is associated with additional health care cost, time, and complications such as pancreatitis, cholangitis, hemorrhage, and perforation. 8 To address both the potential limitations of postoperative bile leak after LSC-F and remnant cholecystitis after reconstituted LSC, we describe the use of a ''falciform patch (FP)'' to obliterate the gallbladder remnant.…”