Subtotal cholecystectomy: early and long-term outcomes
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and Other Interventional Techniques
Subtotal cholecystectomy: early and long‑term outcomes Wee Ming Tay1 · Ying Jie Toh1 · Vishalkumar G. Shelat2 · Cheong Wei Huey2 · Sameer P. Junnarkar2 · Winston Woon2 · Jee Keem Low2 Received: 10 June 2019 / Accepted: 28 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background In difficult gallbladders, partial or subtotal cholecystectomy (SC) has been described as a reasonable procedure with safe outcomes. Our aim was to look at our data on SC with respect to safety, morbidity and long-term outcome. Methods A retrospective analysis was performed for 3560 patients undergoing cholecystectomy from January 2010 to June 2016. For patients who underwent SC, demographics, intra-operative and follow-up details were analysed. Results A total of 168 SC patients were included. 102 (60.7%) were male while 66 (39.3%) were female. The median age was 63 years (31-87). These patients were on follow-up for a median of 29 months (1.7-80). 153 were attempted laparoscopically and there were 25 (16.3%) patients which had open conversion. The rest of the 15 patients had open SC. Mean operative time 150 min (70–315) and average blood loss was 170 ml (50–1500). Median length of stay for these patients was 4 days (1–68). There were no common bile duct (CBD) injuries. We had 12 (7.1%) post-operative collections, 4 (2.4%) wound infections, 1 (0.6%) bile leak and 7 (4.2%) retained stones. Post-operative endoscopic retrograde cholangiopancreatography (ERCP) was performed on 4 (2.4%) patients with successful retrieval of CBD stones. One patient has spontaneous passage of CBD stone. The rest of the two patients with very small retained stones in remnant gallbladder were successfully managed conservatively. There was no 30-day or operation-related mortality. No patient required a second operation. Conclusions SC is safe and feasible when encountering a difficult gallbladder. Keywords Subtotal · Cholecystitis · Difficult gallbladder Laparoscopic cholecystectomy is currently the surgical choice procedure for symptomatic gallstones [1]. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) mentioned that since the introduction of laparoscopic cholecystectomy, bile duct injury rates have increased and occurring in about 3 per 1000 procedures performed. They suggest the use of critical view of safety (CVS) method of identification of the cystic duct and artery during dissection to prevent bile duct injuries [2]. For gallbladders, which have fibrosis or inflammation, they also state that the surgeon should recognise that the dissection is
* Wee Ming Tay [email protected] 1
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
Hepatic, Pancreatic and Biliary (HPB) Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
2
difficult and finish the operation by a safe method if conditions around the gallbladder are too dangerous. In patients with severe gallbladder inflammation and
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