Frequency, Complications, and Predictive Factors for Performing Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit: A Comparative Cohort Study

A bstrAct Aims: Laparoscopic subtotal cholecystectomies (LSCs) are occasionally performed for difficult gallbladder (GB) surgery. The aim of this study is to determine the rate, complications, and factors predictive of performing LSC in a hepatobiliary (HPB) unit, in comparison to patients who have undergone a conventional operation. Materials and methods: A 5-year retrospective review of laparoscopic cholecystectomies (LCs) was performed by HPB team at a tertiary center. Demographic, operative, and postoperative data were identified. A randomized group (generated using online randomization software Research Randomizer®) of LC patients was identified from the study cohort, who had the same data recorded for comparison. Significance level was set at p < 0.05 when comparing the two groups of LC and LSC. Results: A total of 1,613 patients underwent LC, of which, 102 (6.3%) underwent LSC. The complication rate was 12.7% in the LSC group, mainly consisting of bile leak (3.9%) and collection requiring drainage (0.98%). The LC group had a 4.9% complication rate, of which, one bile leak was reported, i.e., 1 (0.98%). The length of stay was significantly longer in the LSC group (2 days vs 0 days in the LC group), and this group also had a slightly higher readmission rate (8.8% vs 3.92%). Laparoscopic subtotal cholecystectomy was found to be more likely in patients with previous cholecystitis, thickened GB wall on imaging and previous endoscopic retrograde cholangiopancreatography (ERCP). Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure and the above characteristics may be used to potentially predict who is more likely to undergo LSC. This may aid in the consenting process and also help to create a score that predicts the probability of undergoing LSC. World (2019):