Bailout Surgery for Difficult Gallbladders: Surgical Approach and Outcomes

Area of Science:

• Gastrointestinal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Acute cholecystitis can complicate cholecystectomy, necessitating bailout procedures like subtotal cholecystectomy to prevent bile duct injury and hemorrhage.
• Bailout procedures, including laparoscopic or open subtotal cholecystectomy, are employed when dissection becomes challenging during standard cholecystectomy.

Purpose of the Study:

• To describe the incidence, risk factors, safety, morbidity, and outcomes of bailout procedures during cholecystectomy.
• To evaluate the effectiveness of subtotal cholecystectomy as an alternative to total cholecystectomy in complex cases.

Main Methods:

• Retrospective review of 1892 cholecystectomies with 147 bailout procedures at a single academic center (January 2015 - December 2020).
• Data included patient demographics, comorbidities, symptom duration, surgical findings, procedure length, and outcomes.
• Analysis compared outcomes of different bailout approaches, including open conversion and subtotal cholecystectomy.

Main Results:

• 147 bailout procedures were performed, with 63.4% converted to open surgery; 66% achieved complete cholecystectomy.
• Common comorbidities included hypertension and diabetes; difficult anatomy and adhesions were primary reasons for bailout.
• Two bile duct injuries occurred (both in open total cholecystectomy), and bile leak occurred in 23.8% (mostly in subtotal group). No significant differences in hospital stay, infection, or mortality were observed among bailout types.

Conclusions:

• Subtotal cholecystectomy is a safe alternative for challenging cholecystectomies, minimizing risks of injury to surrounding structures.
• The choice between laparoscopic or open subtotal cholecystectomy depends on surgeon expertise and patient factors.