Volkan ÖTER, Bahtiyar MUHAMMEDOĞLU, Vehbi ŞIKRIKÇI, Muhammet Kadri ÇOLAKOĞLU

Management of difficult gallbladder and comparison of laparoscopic subtotal cholecystectomy with open subtotal cholecystectomy

Aim: Laparoscopic cholecystectomy is the optimal surgical treatment for benign gallbladder diseases. Under curtain conditions it isvery hard to distinguish the Calot triangle and it becomes difficult to perform safe cholecystectomy. Subtotal cholecystectomy is asalvage option in such conditions. The aim of this study is to compare the results of open and laparoscopic subtotal cholecystectomyin difficult gallbladder management.Material and Methods: In this retrospective study results of all consecutive patients who were performed subtotal cholecystectomybetween July 2014 and August 2017 were collected and laparoscopic and open methods were compared.Results:Forty-five of 396 laparoscopic cholecystectomy cases underwent subtotal cholecystectomy during the study period.Subtotal cholecystectomy was performed laparoscopically in 27 of 45 patients (Group I), and open method in 18 patients (GroupII). Convertion rate was %34.1. No significant difference was observed in terms of both preoperative and postoperative laboratoryresults. There was no difference between two groups in terms of ERCP history. The rate of open operation was statistically higherin acute cases. The duration of surgery was significantly higher in laparoscopic group but length of hospital stay was significantlyhigher in open group. Total cost was higher in group 2 but this result did not reach statistical significance. Total bile leak rate was2.2%.Conclusion: Laparoscopic subtotal cholecystectomy is a safe and appropriate method which can be compared with open subtotalcholecystectomy in difficult gallbladder management.

PDF

___

1. Chung AY, Duke MC. Acute biliary disease. Surg Clin North Am 2018;98:877-894.
2. Thangavelu A, Rosenbaum S, Thangavelu D. Timing of cholecystectomy in acute cholecystitis. J Emerg Med 2018;54:892-7.
3. Soper NJ. Laparoscopic cholecystectomy. Curr Probl Surg 1991;28:581-655.
4. McCoy AC, Gasevic E, Szlabick RE, et al. Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents’ case logs from 2000 to 2011. J Surg Educ 2013;70:683-9.
5. Santos BF, Brunt LM, Pucci MJ. The Difficult Gallbladder: A safe approach to a dangerous problem. J Laparoendosc Adv Surg Tech A 2017;27:571-8.
6. Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy fenestrating vs reconstituting subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg 2016;222:89-96.
7. Booji KA, de REuver PR, Nijsse B, et al. Insufficient safety measures repoerted in operation notes of complicated laparoscopic cholecystectomies. Surgery 2014;155:384-9.
8. Bonilla Naar A. Two new technics for the gallbladder and bile ducts: subtotal cholecysectomy, subject to extension and endohepatofistulojejunostomy. Prensa Med Argent 1954;41:1002-6.
9. Madding GF. Subtotal cholecystectomy in acute cholecystitis. Am J Surg 1955;89:604-7.
10. Kohga A, Suzuki K, Okumura T, et al. Caluculus left in remnant gallbladder cause long-term complications in patients undergoing subtotal cholecystectomy. HPB (Oxford) 2019;21:508-14.
11. Tamura A, Ishii J, Katagiri T, et al. Effectiveness of laparoscopic subtotal cholecystectomy: perioperative and long-term postoperative results. Hepatogastroenterology 2013;60:1280-3.
12. Concors SJ, Kirkland ML, Schuricht AL, et al.. Resection of gallbladder remnants after subtotal cholecystectomy: presentation and management. HPB(Oxford) 2018;20:1062-6.
13. Shin M, Choi N, Yoo Y, et al. Clinical outcomes of subtotal cholecystectomy performed for difficult choecystectomy. Ann Surg Treat Res 2016;91:226-32.
14. Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis. JAMA Surg 2015;150:159-68.