Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy.

Ali Cihat Yildirim,Mustafa Cem Algin,Ozlem Arik,Faik Yaylak,Sezgin Zeren,Mehmet Fatih Ekici

doi:10.7759/cureus.22441

Abstract

PurposeCholecystectomy is one of the most frequently performed surgeries. Although laparoscopy is considered the gold standard approach, it cannot prevent biliary injuries. Subtotal cholecystectomy has been performed mainly to prevent biliary injuries during difficult cholecystectomies. This study aimed to analyse our subtotal cholecystectomy results for difficult cholecystectomy cases and to evaluate the fenestrating and reconstituting techniques.MethodsRetrospective data were collected and analysed statistically for cases that underwent subtotal cholecystectomy in a single referral centre between 2015 and 2020. Comparisons were made of the patients’ age, gender, preoperative American Society of Anaesthesiologists (ASA) score, comorbidities, surgical timing, surgical procedure choice, postoperative complications, and mortality.ResultsThe number of patients who underwent subtotal cholecystectomy was 46; 30.4% underwent emergent surgery and 69.6% underwent elective surgery. Twelve patients had subtotal fenestrating cholecystectomy and 34 had subtotal reconstituting cholecystectomy. Wound issues were noted in 17.4% of the patients, while 10.9% had temporary biliary fistulas that resolved spontaneously. Reoperation was performed in one patient due to high-output biliary drainage. Patients with postoperative complications had significantly higher co-morbid conditions (p=0.000), but surgery timing (p=0.192) and type of subtotal cholecystectomy (p=0.409) had no statistically significant effect on complications. Mortality showed a statistically significant correlation with patient comorbidities, surgery timing, and the type of procedure (p<0.05). Postoperative complications showed a statistically significant correlation with mortality (p<0.05).ConclusionSubtotal cholecystectomy prevents major biliary complications after cholecystectomy. Yet, the frequency of postoperative complications after subtotal cholecystectomy is incontrovertible. Intraoperative characteristics and the surgeon’s expertise decide the optimal choice of the subtotal cholecystectomy technique.

Highlights

Gallstones have a prevalence of 10-15% in the general population, with some differences across countries
Reoperation was performed in one patient due to high-output biliary drainage
Laparoscopic cholecystectomy is the gold standard technique used on patients with symptomatic acute cholecystitis

Summary

Introduction

Gallstones have a prevalence of 10-15% in the general population, with some differences across countries. If acute cholecystitis is the first clinical scenario, approximately 20-40% of patients may develop biliary stonerelated complications [1]. Laparoscopic cholecystectomy is the gold standard technique used on patients with symptomatic acute cholecystitis. The recommendation for these patients is to undergo an early cholecystectomy within 7-10 days of admission. This laparoscopic technique, used in surgery for over 30 years, has a range of difficulties from easy to complicated in gallbladder resections [2,3]. Bile duct injuries are still a concern even with risk-minimising laparoscopic cholecystectomy techniques

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