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Early and Long-Term Outcomes of Laparoscopic Reconstituting Subtotal Cholecystectomy: Impact of Surgical Approach and
Hiroki Kushiya1,2, Shoki Sato1,2, Kentaro Kato1
1Teine Keijinkai General Hospital, Sapporo, Japan.
Purpose:
Laparoscopic cholecystectomy is common, but bile duct injury occurs in 0.3% of cases. Moderate to severe cholecystitis increases operative difficulty, and subtotal cholecystectomy is recommended as a preventive procedure. This study evaluated the outcomes of reconstituting subtotal cholecystectomy for cholecystitis at our institution.
Methods:
We retrospectively analyzed 2707 patients who underwent cholecystectomy between January 2010 and December 2022. Of these, 109 patients underwent reconstituting subtotal cholecystectomy. Patients were classified into a laparoscopic group (36 cases) and an open conversion group (73 cases). Short- and long-term outcomes were compared.
Results:
No bile duct injuries or operation-related deaths occurred. The laparoscopic group had significantly less blood loss and a shorter postoperative hospital stay. In almost all open conversion cases, the gallbladder stump was closed with sutures, whereas stapler closure was mainly used laparoscopically. Three cases of retained stone cholecystitis occurred in the laparoscopic stapler group, whereas no cases occurred in the laparoscopic suture group or open conversion group.
Conclusions:
Laparoscopic reconstituting subtotal cholecystectomy is an acceptable surgical approach; however, retained stone-related complications require particular attention when stapled stump closure is performed, as the stump closure method may be more closely associated with these complications than the surgical approach.