World Journal of Laparoscopic Surgery

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VOLUME 12 , ISSUE 2 ( May-August, 2019 ) > List of Articles

Original Article

Frequency, Complications, and Predictive Factors for Performing Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit: A Comparative Cohort Study

Alexia Farrugia, Niranjan Ravichandran, Majid Ali, Harry Blege, Saboor Khan, For Tai Lam, Jawad Ahmad, Gabriele Marangoni

Keywords : Gallbladder, Laparoscopic cholecystectomy, Predictive factors, Subtotal cholecystectomy

Citation Information : Farrugia A, Ravichandran N, Ali M, Blege H, Khan S, Lam FT, Ahmad J, Marangoni G. Frequency, Complications, and Predictive Factors for Performing Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit: A Comparative Cohort Study. World J Lap Surg 2019; 12 (2):53-55.

DOI: 10.5005/jp-journals-10033-1369

License: CC BY-NC 4.0

Published Online: 01-06-2016

Copyright Statement:  Copyright © 2019; The Author(s).


Aims: Laparoscopic subtotal cholecystectomies (LSCs) are occasionally performed for difficult gallbladder (GB) surgery. The aim of this study is to determine the rate, complications, and factors predictive of performing LSC in a hepatobiliary (HPB) unit, in comparison to patients who have undergone a conventional operation. Materials and methods: A 5-year retrospective review of laparoscopic cholecystectomies (LCs) was performed by HPB team at a tertiary center. Demographic, operative, and postoperative data were identified. A randomized group (generated using online randomization software Research Randomizer®) of LC patients was identified from the study cohort, who had the same data recorded for comparison. Significance level was set at p < 0.05 when comparing the two groups of LC and LSC. Results: A total of 1,613 patients underwent LC, of which, 102 (6.3%) underwent LSC. The complication rate was 12.7% in the LSC group, mainly consisting of bile leak (3.9%) and collection requiring drainage (0.98%). The LC group had a 4.9% complication rate, of which, one bile leak was reported, i.e., 1 (0.98%). The length of stay was significantly longer in the LSC group (2 days vs 0 days in the LC group), and this group also had a slightly higher readmission rate (8.8% vs 3.92%). Laparoscopic subtotal cholecystectomy was found to be more likely in patients with previous cholecystitis, thickened GB wall on imaging and previous endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure and the above characteristics may be used to potentially predict who is more likely to undergo LSC. This may aid in the consenting process and also help to create a score that predicts the probability of undergoing LSC.

  1. Vracko J, Hunt MY, Wiechel KL. Safe laparoscopic cholecystectomy. Surg Endosc 2005;19(12):1666. DOI: 10.1007/s00464-004-2138-y.
  2. Wolf AS, Nijsse BA, Sokal SM, et al. Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg 2009;197(6): 781–784. DOI: 10.1016/j.amjsurg.2008.05.010.
  3. Beldi G, Glattli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 2003;17(9):1437–1439. DOI: 10.1007/s00464-002-9128-8.
  4. Krahenbuhl L, Sclabas G, Wente MN, et al. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg 2001;25(10):1325–1330. DOI: 10.1007/s00268-001-0118-0.
  5. Henneman D, da Costa DW, Vrouenraets BC, et al. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 2013;27(2):351–358. DOI: 10.1007/s00464-012-2458-2.
  6. Michalowski K, Bornman PC, Krige JE, et al. Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 1998;85(7):904–906. DOI: 10.1046/j.1365-2168.1998.00749.x.
  7. Sinha I, Smith ML, Safranek P, et al. Laparoscopic subtotal cholecystectomy without cystic duct ligation. Br J Surg 2007;94(12):1527–1529. DOI: 10.1002/bjs.5889.
  8. Nakajima J, Sasaki A, Obuchi T, et al. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today 2009;39(10): 870–875. DOI: 10.1007/s00595-008-3975-4.
  9. Harilingam MR, Shrestha AK, Basu S. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience. J Minim Access Surg 2016;12(4):325–329. DOI: 10.4103/0972-9941.181323.
  10. Palanivelu C, Rajan PS, Jani K, et al. Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants. J Am Coll Surg 2006;203(2):145–151. DOI: 10.1016/j.jamcollsurg.2006.04.019.
  11. Horiuchi A, Watanabe Y, Doi T, et al. Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc 2008;22(12):2720–2723. DOI: 10.1007/s00464-008-9879-y.
  12. Singhal T, Balakrishnan S, Hussain A, et al. Laparoscopic subtotal cholecystectomy: initial experience with laparoscopic management of difficult cholecystitis. Surgeon 2009;7(5):263–268. DOI: 10.1016/S1479-666X(09)80002-4.
  13. Tamura A, Otsuka Y, Tsuchiya M, et al. Perioperative and long follow up evaluation of laparoscopic subtotal cholecystectomy. HPB 2012;2:338.
  14. Ali L, Bashir T, Bashir S. Laparoscopic subtotal cholecystectomy in difficult cholecystitis - our experience. Pak J Med Health Sci 2015;9(3):917–919.
  15. Peker KD, Alis H. Laparoscopic subtotal cholecystectomy could be an alternative to conversion. Med J Bakirkoy 2017;13(3):113–117. DOI: 10.5350/BTDMJB201713301.
  16. Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis. JAMA Surg 2015;150(2):159–168. DOI: 10.1001/jamasurg.2014.1219.
  17. van Dijk AH, Donkervoort SC, Lameris W, et al. Short- and long-term outcomes after a reconstituting and fenestrating subtotal cholecystectomy. J Am Coll Surg 2017;225(3):371–379. DOI: 10.1016/j.jamcollsurg.2017.05.016.
  18. Kim Y, Wima K, Jung AD, et al. Laparoscopic subtotal cholecystectomy compared to total cholecystectomy: a matched national analysis. J Surg Res 2017;218:316–321. DOI: 10.1016/j.jss.2017.06.047.
  19. Chowbey P, Sharma A, Goswami A, et al. Residual gallbladder stones after cholecystectomy: a literature review. J Minim Access Surg 2015;11(4):223–230. DOI: 10.4103/0972-9941.158156.
  20. Jeong IO, Kim JY, Choe YM, et al. Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis. Korean J Hepatobiliary Pancreat Surg 2011;15(4):225–230. DOI: 10.14701/kjhbps.2011.15.4.225.
  21. Shingu Y, Sakamoto E, Norimizu S. Preoperative prediction of laparoscopic subtotal cholecystectomy for severe cholecystitis. Am J Gastroenterol 2015;1:S27. DOI: 10.14309/00000434-201510001-00064.
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