Early Laparoscopic Cholecystectomy Using the Bailout Procedure for Acute Cholecystitis with Severe Local Inflammation

Abstract

Introduction: The Tokyo Guidelines 2018 have proposed a bailout procedure that includes the fundus first technique and subtotal cholecystectomy to prevent bile duct injury and vasculo-biliary injury in acute cholecystitis (AC) with severe local inflammation, especially at Calot's triangle. The study aim was to assess the influence of laparoscopic cholecystectomy (LC) using the bailout procedure for AC with severe local inflammation. Patients and methods: A total of 362 patients were enrolled during 15-year study period. The median preoperative length of hospitalization was 1 day (range, 0-30 days). The patient's characteristics, therapeutic strategies, and operative results were compared between the former period (n = 260) and a recent 3-year period (n = 102). Results: In both groups, approximately 20% of the patients with taking antithrombotic agents, and approximately 30% of the patients had severe local inflammation, including gangrenous cholecystitis. Early LC within 4 days after admission was predominantly performed in the recent period (100 cases, 98.0%, p < 0.001). Conversion to open surgery decreased from 6.5% to 1.0%, and postoperative complication was decreased from 4.2% to 2.0%. The postoperative and total length of hospitalization were significantly shorter in the recent period than in the earlier period (3 days and 5 days, respectively). Conclusions: Active performance of the bailout procedure and technical modification were associated with fewer conversion to open surgery and postoperative complications, leading to significant decreases in the postoperative and total length of hospitalization for AC patients with severe local inflammation.