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J Minim Access Surg. 2019 Oct 1. doi: 10.4103/jmas.JMAS_124_19. [Epub ahead of print]

Re-interventions and re-admissions in a 13-year series following use of laparoscopic subtotal cholecystectomy.

Author information

1
Department of Upper Gastrointestinal Surgery, Royal Berkshire Hospital, Reading, United Kingdom.

Abstract

Background:

Laparoscopic subtotal cholecystectomy (LSTC) without cystic duct ligation is an alternative to conversion to open surgery in a difficult cholecystectomy, thus avoiding a potentially hazardous dissection in Calot's triangle. The long-term outcomes of this procedure are not well reported. The aim of this study is to assess the rates of re-presentation, re-admissions, endoscopic interventions and completion cholecystectomy in patients who have undergone LSTC.

Methods:

Details of all patients undergoing cholecystectomy over a 13-year period (2003-2015) were entered on a prospective database. Further information on subsequent hospital attendances, biliary imaging, endoscopic interventions and re-operations following the index LSTC was collected retrospectively from hospital database.

Results:

Overall, 2313 patients underwent laparoscopic cholecystectomy. Eighty-five patients (3.7%) underwent LSTC and the rest had standard laparoscopic cholecystectomy. A controlled bile leak was observed in 16 (19%) patients post-operatively, of which 3 resolved spontaneously. The remaining 13 were managed with an early endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent. Twenty-seven patients (32%), who underwent LSTC, were re-investigated for the upper abdominal symptoms. The time range for re-investigation was 21 days-124 months. Eight patients underwent ERCP post-discharge, for suspected bile duct stones on radiological imaging. Two patients required open completion cholecystectomy for symptomatic stones in the gallbladder remnant.

Conclusion:

LSTC is a feasible and safe alternative to open surgery with acceptable long-term consequences and re-interventions.

KEYWORDS:

Gallbladder; laparoscopic cholecystectomy; laparoscopic subtotal cholecystectomy; subtotal cholecystectomy

PMID:
31571673
DOI:
10.4103/jmas.JMAS_124_19
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