OGBN P10 Fenestrating versus reconstituting subtotal cholecystectomy for difficult gallbladder: A systematic review and meta-analysis

Abstract

Abstract Background To evaluate comparative outcomes of fenestrating and reconstituting subtotal cholecystectomy (STC) in patients with difficult gallbladder. Methods A systematic search of electronic data sources and bibliographic reference lists were conducted. All comparative studies reporting outcomes of laparoscopic fenestrating and reconstituting STC were included and their risk of bias were assessed using ROBINS-I tool. Results Seven comparative studies were included enrolling 590 patients undergoing laparoscopic STC using either fenestrating (n=353) or reconstituting (n=237) approaches. Although fenestrating STC was associated with a significantly higher rate of bile leak (OR:2.47, p=0.007) compared to reconstituting STC, both approaches were comparable in terms of resolution of bile leak without (RD:-0.02, p=0.86) or with (OR:1.84, p=0.40) postoperative ERCP. Moreover, there was no significant difference in development of bile duct injury (RD:-0.02, p=0.16), need for postoperative ERCP (OR:1.36, p=0.49), wound infection (RD:0.03, p=0.27), re-operation (OR:0.95, p=0.95), gallbladder remnant cholecystitis (OR:0.21, p=0.09) or need for completion cholecystectomy (RD:0.01, p=0.59) between two groups. Conclusions Although fenestrating STC increases risk of bile leak compared with the reconstituting approach, this can be managed successfully with postoperative ERCP if not resolved spontaneously. We encourage low threshold for fenestrating approach in difficult situations, considering its relatively benign postoperative course and long-term outcomes.