Subtotal Fenestrating Cholecystectomy: A Safe and Effective Approach to the Difficult Gallbladder

Byskosh, Alexandria; Stocker, Benjamin; Liu, Daniel Y.; Li, Jennifer; Gastevich, Benjamin; Devin, Courtney L.; Quach, Giang; Weiss, Hannah; Posluszny, Joseph A.

doi:10.1016/j.jss.2022.09.014

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…Older patients have been shown to have more complex biliary disease than younger patients 30 . Patients undergoing LSC in this study were significantly older which is similar to findings in previously reported studies 28,31 . Patients presenting with acute cholecystitis or undergoing a same admission cholecystectomy were significantly more likely to undergo an LSC.…”

Section: Discussionsupporting

confidence: 86%

“…30 Patients undergoing LSC in this study were significantly older which is similar to findings in previously reported studies. 28,31 Patients presenting with acute cholecystitis or undergoing a same admission cholecystectomy were significantly more likely to undergo an LSC. According to the Tokyo 2018 guidelines, the degree of severity of acute cholecystitis correlates with an increased risk of BDI.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic subtotal cholecystectomy outcomes across a low‐and middle‐income country metropolitan health service

Booyse,

Lindemann,

Calitz

et al. 2024

World j. surg.

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BackgroundLaparoscopic subtotal cholecystectomy (LSC) is a safe alternative for difficult cholecystectomies to prevent bile duct injury and open conversion. The primary aim was to detail the use and outcomes on LSCs.MethodsRetrospective analysis of a prospectively maintained database of laparoscopic cholecystectomy (LC). Relative clinical factors, outcomes, and 30‐day follow‐up between LSC and LC were compared using univariate and multivariate analyses.ResultsSix hundred and twenty four cholecystectomies were performed and 53 (8.5%) required LSC. 81.8% were fenestrating LSC. Male sex was significantly overrepresented in the LSC group (p < 0.01) and patients requiring LSC were significantly older (p < 0.01). Same admission cholecystectomy was associated with a higher risk of LSC (p < 0.01). Patients with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy had an increased risk of undergoing LSC (p < 0.01). A necrotic gallbladder was the most significant predictor of the need for a LSC (p < 0.001). A contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation were significant predictors of difficulty (all p < 0.01). Postoperative complications occurred in 26.4% of LSC patients. There were ten (18.9%) Clavien–Dindo Grade III complications, 5.7% required ERCPs, and 9.4% required relook laparotomies. Significantly, more patients in the LSC group developed bile leaks (n = 8, 15%) (p < 0.001). There were two readmissions within 30 days, one mortality, and no BDIs occurred in the LSC cohort.ConclusionLSC provides a feasible surgical option that should be utilized in complex cholecystitis.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Laparoscopic subtotal cholecystectomy outcomes across a low‐and middle‐income country metropolitan health service

Booyse,

Lindemann,

Calitz

et al. 2024

World j. surg.

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show abstract

“…Multiple factors associated to subtotal cholecystectomy have been identified such as male sex (OR = 2.59) (7), older age (OR = 1.23) (7), ASA score of ≥3 (OR = 3.84) (15), white blood cells (WBC) (OR = 2.02) (7), albumin level (OR = 0.31) (16), preoperative diagnosis of acute on chronic cholecystitis (OR = 5.47) (7), acute cholecystitis (OR = 2.69) (16), higher Tokyo grade for severity of acute cholecystitis (OR = 2.37) (17), history of liver disease (OR = 8.40) (16), time from onset to surgery (OR = 5.31) (15), previous biliary tract drainage (cholecystostomy) (OR = 2.66) (16,18). Image findings have also been reported such as obscuration of the gallbladder wall around the neck (OR = 10.56) (15) and disruption of the common hepatic duct (OR = 3.92) (15), amongst others (Table 1).…”

Section: Risk Factorsmentioning

confidence: 99%

State of the art in subtotal cholecystectomy: An overview

2023

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IntroductionSubtotal cholecystectomy is a type of surgical bail-out procedure indicated when facing difficult laparoscopic cholecystectomy due to not reaching the critical view of safety, inadequate identification of the anatomical structures involved and/or risk of injury.Materials and methodsA comprehensive search on PubMed were performed using the following Mesh terms: Subtotal cholecystectomy and Partial cholecystectomy. The PubMed databases were used to search for English-language reports related to Subtotal cholecystectomy between January 1, 1987, the date of the first published laparoscopic cholecystectomy, through January 2023. 41 studies were included.ResultsSubtotal cholecystectomy's incidence oscillates between 4.00% and 9.38%. Strasberg et al., divided subtotal cholecystectomies in “fenestrating” and “reconstituting” types based on if the remaining portion of the gallbladder was left open or closed. Subtotal cholecystectomy can sometimes be a challenging procedure and is associated to a high rate of complications such as biliary fistula, retained gallstones, subhepatic or subphrenic collections, among others.ConslusionSubtotal cholecystectomy is a safe alternative when facing difficult cholecystectomy in which the critical view of safety is not reached in order to avoid complications. A classification system should be implemented in surgical descriptions to compare the different surgical techniques employed. In order to avoid bile leakage and cholecystitis of the remnant gallbladder, the surgical technique must be performed skillfully. There is still a current lack of information on alternative techniques such as omental plugging or falciform patch in order to judge their utility. There needs to be further research on long-term complications such as malignancy of the remnant gallbladder.

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How do magnetic resonance cholangiopancreatography findings predict conversion from laparoscopic cholecystectomy for acute cholecystitis to bailout procedures?

Sekioka¹,

Ota²,

Ito³

et al. 2023

Surgery

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Subtotal Fenestrating Cholecystectomy: A Safe and Effective Approach to the Difficult Gallbladder

Cited by 7 publications

References 25 publications

Laparoscopic subtotal cholecystectomy outcomes across a low‐and middle‐income country metropolitan health service

Laparoscopic subtotal cholecystectomy outcomes across a low‐and middle‐income country metropolitan health service

State of the art in subtotal cholecystectomy: An overview

How do magnetic resonance cholangiopancreatography findings predict conversion from laparoscopic cholecystectomy for acute cholecystitis to bailout procedures?

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