Laparoscopic Subtotal Cholecystectomy for Difficult Gallbladders: Single-Center Retrospective Cohort Study.

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Minimally Invasive Surgical Techniques
• Surgical Outcomes Research

Background:

• Difficult cholecystectomy cases present challenges including increased operative time, bleeding, and risk of bile duct injury.
• Laparoscopic subtotal cholecystectomy (LSC) serves as a valuable bail-out procedure in complex gallbladder surgeries.
• LSC offers a manageable and safer alternative compared to attempting a complete laparoscopic total cholecystectomy (LTC) in challenging situations.

Purpose of the Study:

• To compare the postoperative outcomes between laparoscopic total cholecystectomy (LTC) and laparoscopic subtotal cholecystectomy (LSC).

Main Methods:

• A retrospective, cross-sectional study was conducted at King Fahd Hospital of the University, Saudi Arabia, from 2010 to 2020.
• Included patients aged over 18 who underwent either laparoscopic subtotal or total cholecystectomy.
• Data analysis focused on comparing patient demographics, diagnoses, conversion rates, and postoperative outcomes.

Main Results:

• Only 21 of 636 patients underwent LSC; these patients were more commonly diagnosed with acute cholecystitis.
• LSC was associated with a significantly higher rate of postoperative drain placement (71.4% vs 7.8%), longer hospital stay (9.14 days vs 4.6 days), and increased reoperation rate (9.5% vs 0.7%).
• A significant association was found between white blood cell (WBC) count, reticulocyte levels, and conversion to LSC.

Conclusions:

• Laparoscopic subtotal cholecystectomy is a viable option for difficult cholecystectomies where total removal is not feasible, but potential complications must be considered.
• The study highlights increased postoperative morbidity associated with LSC compared to LTC.
• Further prospective research is recommended to explore patient-specific factors influencing LSC outcomes.