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

Abstract

Background: Operating on difficult cholecystectomy with the intent to proceed with total cholecystectomy can be associated with longer postoperative time, excessive bleeding, and increased risk of intraoperative bile duct injury and other complications. Subtotal cholecystectomy is a part of bail-out procedures recommended in cases of difficult cholecystectomy. It is a convenient alternative to total cholecystectomy as it is a comparatively more manageable and safer treatment procedure.

Objective: The aim of this study was to assess the difference in outcomes between laparoscopic total cholecystectomy (LTC) and laparoscopic subtotal cholecystectomy (LSC).

Methods: This retrospective, cross-sectional study was conducted at King Fahd Hospital of the University (KFHU), Saudi Arabia, between 2010 to 2020. The study included patients over 18 years of age who underwent laparoscopic (subtotal and total) cholecystectomy at KFHU.

Results: Out of 636 cases in the study period, only 21 patients underwent laparoscopic subtotal reconstituting cholecystectomy. The laparoscopic total cholecystectomy group was more diagnosed with biliary colic (56.1%), whereas those who underwent laparoscopic subtotal cholecystectomy were mainly diagnosed with acute cholecystitis (66.7%). We found a significant association between WBC, reticulocyte count level, and the conversion to LSC. Regarding postoperative outcomes, only 7.8% had a drain in the laparoscopic total cholecystectomy group compared to the majority (71.4%) in the laparoscopic subtotal cholecystectomy group (p<0.0001). A significantly longer length of stay was reported in the subtotal cholecystectomy group (9.14±7.63 versus 4.6±3.84) and a greater rate of reoperation (9.5% versus 0.7%).

Conclusion: Laparoscopic subtotal cholecystectomy should be performed in difficult cases when total cholecystectomy is not possible, considering the possible complications of subtotal cholecystectomy. More prospective studies should take into consideration other patient-related factors that might influence postoperative outcomes and overall success rates.