Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Patient Outcomes

Background:

• Difficult laparoscopic cholecystectomies present challenges.
• Conversion to open procedure (CO) and subtotal laparoscopic cholecystectomy (SLC) are bailout strategies.
• Evaluating morbidity and mortality associated with these bailout procedures is crucial.

Purpose of the Study:

• To compare morbidity and mortality between CO and SLC as bailout procedures for difficult laparoscopic cholecystectomies.
• To identify prognostic factors for morbimortality in these patient groups.

Main Methods:

• Retrospective observational cohort study.
• Analysis of 675 patients undergoing CO or SLC between 2014 and 2022.
• Univariable and multivariable logistic regression for prognostic factor identification.

Main Results:

• Neither CO nor SLC showed an increased risk of overall major complications.
• CO was associated with higher risks of bile duct injury, bleeding, intestinal injury, and wound infection.
• SLC had a higher risk of bile leak, but fewer severe complications overall compared to CO.

Conclusions:

• Subtotal laparoscopic cholecystectomy (SLC) appears to be associated with fewer complications than conversion to open procedure (CO).
• There is limited evidence regarding the long-term outcomes of SLC.
• Further research is necessary to establish the long-term safety and efficacy of SLC as a bailout procedure.