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Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis
Sylvia Sj Koo1, Rohin J Krishnan2, Kyle Ishikawa3
1John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, USA; Department of Surgery, The Queen's Medical Center, Honolulu, HI, 96813, USA.
American Journal of Surgery
|January 3, 2024
Summary
Subtotal cholecystectomy (SC) is a viable option for difficult gallbladder cases, potentially reducing common bile duct (CBD) injuries. However, SC may increase risks of bile leaks and reoperation compared to total cholecystectomy (TC).
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biliary Surgery
Background:
- Laparoscopic cholecystectomy can be challenging with severely inflamed gallbladders.
- Subtotal cholecystectomy (SC) is an alternative procedure for difficult cases.
- Limited comparative data exists between SC and total cholecystectomy (TC) in severe inflammation.
Purpose of the Study:
- To compare the safety and efficacy of SC versus TC in patients with difficult gallbladders.
- To evaluate outcomes including common bile duct (CBD) injury, bile leaks, and reoperation rates.
Main Methods:
- A meta-analysis was conducted, including ten studies comparing SC and TC for difficult gallbladders.
- Databases searched include Medline-OVID, Embase-OVID, and Cinahl.
- Primary outcome was CBD injury; secondary outcomes included bile leak, duodenal injury, retained stone, bleeding, intraabdominal collection, wound infection, reoperation, and mortality.
Main Results:
- SC significantly reduced the risk of CBD injury compared to TC (0% vs. 1.6%).
- However, SC was associated with increased risks of bile leaks (RR 3.5), postoperative ERCP (RR 2.86), intraabdominal collections (RR 2.55), and reoperation (RR 2.92).
Conclusions:
- SC presents a reasonable alternative for managing difficult gallbladders, potentially lowering CBD injury rates.
- Understanding the trade-offs between SC and TC is crucial for minimizing harm in complex gallbladder surgeries.
- Further research is warranted to fully elucidate the benefits of SC in challenging cholecystectomies.
