Subtotal Cholecystectomy: Results of a Single-Center, Registry-Based Retrospective Cohort Study of 180 Adults in 2011-2018

Raimundas Lunevicius*, Juanita A. Haagsma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)

Abstract

Introduction: Data on subtotal cholecystectomy (STC) as an alternative to conventional cholecystectomy in difficult surgical situations are limited. This multiaspectual report aims to reduce the STC-specific knowledge gap and inform clinical decision-making strategies. Materials and Methods: All 180 patients who underwent STC at a single center between 2011 and 2017 were assessed in this retrospective cohort study. Their outcomes were followed up until March 23, 2018. Six subgroups stratified by surgical setting (elective/nonelective), surgical approach used (open/laparoscopic), and type of STC (reconstituting/fenestrating) were compared. Results: The ratio of conventional to STC procedures was 13:1. Of the 180 patients, 150 had a history of hospitalization for the acute biliary disease. The proportion of all cholecystectomies that were STC ranged from 1% to 71% between individual surgeons; similarly, laparoscopic STC comprised 0%-97% of all STCs. STC was associated with high intraoperative (n = 19; 10.6%) and short-Term postoperative (n = 159; 88.3%) complication rates. There were three significant intraoperative complications-bleeding (n = 8; 4.4%), bile duct injury (n = 7; 3.9%), and intestinal injury (n = 4; 2.2%). The most common postoperative surgical site complications were external bile leak (21%), wound infection (17%), and biloma (10%). Associations between fenestrating STC and the rates of postoperative bile leak and retained gallstones, mainly in the main bile duct, were detected. Conclusions: STC-Associated perioperative morbidity is significant. There is a substantial investigation burden. Injuries can be avoided when conversion to STC is timely, and its technical variant is correctly selected. The STC rate is a potential key performance indicator monitoring gallbladder surgery practice.

Original languageEnglish
Pages (from-to)1019-1033
Number of pages15
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume31
Issue number9
DOIs
Publication statusPublished - 15 Sept 2021

Bibliographical note

Publisher Copyright:
© Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.

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