Laparoscopic Completion Cholecystectomy: An Audit from the Americas Hepato-Pancreato-Biliary Association (AHPBA) Caribbean Chapter.

Shamir O Cawich,Rene Ramnarace,Patrick Fa Si Oen,Kimon Bonadie,Wesley Francis,Lindberg Simpson,Sanjib K Mohanty,Yardesh Singh,Vijay Naraynsingh

doi:10.7759/cureus.11126

Abstract

ObjectiveRemoval of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean. MethodsWe carried out an audit of the databases from all hepatobiliary surgeons in the Anglophone Caribbean. We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018. Retrospective chart review was performed to extract the following data: patient demographics, diagnoses, presenting complaints, operative details, morbidity, mortality, and clinical outcomes. Descriptive statistics were generated using Statistical Packaging for Social Sciences (SPSS), version 12.0 (SPSS Inc., Chicago IL)ResultsThere were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant. There were 10 women and two men at a mean age of 47.4 years (range 32-60; standard deviation (SD) +/-7.81; median 48; mode 52) and a mean body mass index (BMI) of 30.8 Kg/M2 (SD +/-3.81; range 26-38; median 29.5). The mean interval between the index operation and the completion operation was 14.8 months (SD +/- 12.3; range 1-48; median 13; mode 18). Five (42%) patients had their original cholecystectomy using the open approach. Five (42%) index operations were done on an emergent basis and the gallbladder remnant was deliberately left behind in three (25%) index operations. The completion cholecystectomies were all completed laparoscopically in 130.5 minutes (SD +/- 30.5; range 90-180, median 125; mode 125) without any conversions or mortality. There were two minor bile leaks that resolved without intervention through an indwelling drain. DiscussionCompletions cholecystectomy can be completed via the laparoscopic approach with good outcomes and acceptable morbidity and mortality rates. The patients derive the same advantages as elective cholecystectomies. Therefore, the laparoscopic approach, when performed by hepatobiliary surgeons with advanced laparoscopic expertise in specialized centers, should be the new standard of care.

Highlights

Laparoscopic cholecystectomy is a basic operation that is performed routinely by general surgeons in the Caribbean
We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018
There were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant

Summary

Introduction

Laparoscopic cholecystectomy is a basic operation that is performed routinely by general surgeons in the Caribbean. Many surgeons who encounter difficulty when dissecting Calot’s triangle will opt for a partial cholecystectomy to prevent iatrogenic bile duct injury (BDI) [1,2,3]. The gallbladder remnant may become diseased and a completion operation to remove the remnant becomes necessary [4,5,6,7]. There are isolated reports of laparoscopic completion operations in the Caribbean [4,5], the true incidence of symptomatic remnants remains unknown. How to cite this article Cawich S O, Mohanty S K, Bonadie K, et al (October 24, 2020) Laparoscopic Completion Cholecystectomy: An Audit from the Americas HepatoPancreato-Biliary Association (AHPBA) Caribbean Chapter.

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Results

Conclusion