Predictive factors for subtotal cholecystectomy in delayed elective cholecystectomy after the acute presentation

Abstract

Background: Approximately 15% of adults in the United Kingdom (UK) are predicted to have gallstone disease, with about 80% of these having asymptomatic gallstones. Patients with symptomatic gallstone disease are recommended to undergo cholecystectomy. Currently, in the UK approximately 60,000 cholecystectomies are performed. During complex laparoscopic cholecystectomies, surgeons may still need to resort to historic procedures such as an open cholecystectomy (5-10%) or even a cholecystostomy. Alternatively considering a subtotal cholecystectomy has been shown to reduce the need for conversion to an open procedure. The aim of our study is to identify pre-operative factors that would predict the need for a subtotal cholecystectomy.Methods: A retrospective study, over a period of 01 March 2019 to 29 February 2020 was undertaken at one of London’s major tertiary centres. We reviewed all adult patients that had undergone laparoscopic cholecystectomies and subtotal cholecystectomies.Results: 243 patients were included in the study after being vetted through the inclusion and exclusion criteria, 95 males and 148 females. 243 patients were identified initially for elective cholecystectomy. 230 were managed surgically, 208 with a total laparoscopic cholecystectomy, and 22 with subtotal laparoscopic cholecystectomy. 243 patients were identified initially for elective cholecystectomy. 230 were managed surgically, 208 with a total laparoscopic cholecystectomy, and 22 with subtotal laparoscopic cholecystectomy.Conclusions: Age, male sex, body mass index (BMI) greater than 30 kg/m2 patients, previous endoscopic retrograde cholangiopancreatography (ERCP), thickened gallbladder walls, and raised preoperative leucocytosis were associated with a greater risk of patients consented for laparoscopic cholecystectomies to undergo a conversion to a subtotal cholecystectomy.