Should laparoscopy be the initial approach for completion cholecystectomy in recurrent cholecystitis after subtotal cholecystectomy?

Abstract

Presenter: Ileana Horattas MD | Cleveland Clinic, Akron General Background: Subtotal cholecystectomy has become a widely accepted alternative for patients presented with acute cholecystitis resulting in significant inflammation and anatomic distortion. Recurrent cholecystitis of the remnant gallbladder is an accepted complication of this procedure. International studies have shown completion cholecystectomy to be the definitive management of recurrent cholecystitis. Few investigators in the United States have focused on management of this scenario, and to this point open surgical approach has been recommended. Methods: Cholecystectomies undertaken by one hepatobiliary surgeon over a two-year period from 2017-2019 were reviewed. Cases of patients with previous cholecystectomy who then presented with acute cholecystitis and underwent laparoscopic completion cholecystectomy were compiled and reviewed to determine interval from initial cholecystectomy, operative time, use of intraoperative cholangiography, use of intraoperative indocyanine green (ICG), placement of drain, and total length of hospital stay (LOS). Results: Seven patients met inclusion criteria. The mean interval from initial cholecystectomy was 22 months (range 3-89 months with one patient presenting an unknown length of time from initial operation). Mean operative time was 119 minutes (range 79 minutes to 141 minutes). Five patients had an intraoperative cholangiogram and one case was completed with intraoperative ICG. A drain was left at the completion of three out of seven cases. Average LOS was less than one day (range 0-2) with three patients discharged in good condition post-operative day 0. No patients required an open operation. Conclusion: Laparoscopy is a safe and effective approach to completion cholecystectomy for patients with recurrent cholecystitis that avoids an open surgical procedure.