It is important to establish the difficulty of a cholecystectomy preoperatively to improve the outcomes. There are multiple risk factors for a difficult cholecystectomy that may depend on the patient, the disease, or extrinsic factors. The aim of this study is to evaluate the predictive capacity of a difficult cholecystectomy with a preoperative scale. A diagnostic trial study was designed to evaluate the performance of a scale to predict the difficulty of laparoscopic cholecystectomy, considering as a reference standard the intraoperative findings evaluated according to an intraoperative difficulty scale. A ROC curve was performed and used to estimate predictive value of the preoperative score to predict the difficulty of a cholecystectomy preoperatively. The ROC curve shows an area of 0.88 under the curve. The calculated ideal cutoff was 8, with a sensitivity, specificity, positive predictive value and negative predictive value of 75.15%, 88.31%, 87.32 and 76.83%, respectively. It was demonstrated that, as the difficulty predicted by the preoperative scale increases, the rate of conversion to open procedure, the rate of subtotal cholecystectomies, the rate of complication and the rate of a critical view of safety failed increase. We suggest implementing the preoperative scale in all patients who are planning laparoscopic cholecystectomy, considering it a simple and easy tool to perform. This to inform the patient, organize the surgery schedule, select personnel, request support and have adequate pre-operative planning. Graphical abstract

IntroductionSubtotal cholecystectomy is a type of surgical bail-out procedure indicated when facing difficult laparoscopic cholecystectomy due to not reaching the critical view of safety, inadequate identification of the anatomical structures involved and/or risk of injury.Materials and methodsA comprehensive search on PubMed were performed using the following Mesh terms: Subtotal cholecystectomy and Partial cholecystectomy. The PubMed databases were used to search for English-language reports related to Subtotal cholecystectomy between January 1, 1987, the date of the first published laparoscopic cholecystectomy, through January 2023. 41 studies were included.ResultsSubtotal cholecystectomy's incidence oscillates between 4.00% and 9.38%. Strasberg et al., divided subtotal cholecystectomies in “fenestrating” and “reconstituting” types based on if the remaining portion of the gallbladder was left open or closed. Subtotal cholecystectomy can sometimes be a challenging procedure and is associated to a high rate of complications such as biliary fistula, retained gallstones, subhepatic or subphrenic collections, among others.ConslusionSubtotal cholecystectomy is a safe alternative when facing difficult cholecystectomy in which the critical view of safety is not reached in order to avoid complications. A classification system should be implemented in surgical descriptions to compare the different surgical techniques employed. In order to avoid bile leakage and cholecystitis of the remnant gallbladder, the surgical technique must be performed skillfully. There is still a current lack of information on alternative techniques such as omental plugging or falciform patch in order to judge their utility. There needs to be further research on long-term complications such as malignancy of the remnant gallbladder.

Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

Objetivo: Existen diferencias en la descripción de la vena cística en la literatura, en muchas ocasiones sin considerarla un elemento importante. Consideramos que es de vital importancia describir la presencia de la vena cística como elemento significativo que puede alterar la vista critica de seguridad durante las colecistectomías, y asimismo originar errores. Materiales y métodos: Entre el 1 de enero de 2014 hasta el 31 de diciembre de 2018, se evaluó la presencia de la vena cística durante la disección del triángulo hepatocístico en las colecistectomías. Resultados: 397 colecistectomías laparoscópicas fueron realizadas, en 30 casos se evidenciaron elementos adicionales en el triángulo hepatocístico, que requirieron una disección prolija, la cual después de seguir su trayecto y al evaluar otros reparos anatómicos como el surco de Rouvière y la visualización de la vía biliar, se consideró debido a sus características que se trataba de una vena cística en 8 casos (2%). Discusión: La vena cística es una estructura anatómica cuya existencia se debe tener en mente por parte del cirujano que realiza la colecistectomía laparoscópica, porque puede aparecer como un elemento significativo alterando la vista critica de seguridad. Aunque en nuestra serie como elemento significativo es del 2%, otras series la describen con una frecuencia mucho mayor.Conclusión: Es necesario realizar más estudios sobre la presencia e importancia como reparo anatómico debido a su valor para prevenir lesiones de la vía biliar y como factor de confusión en la vista crítica de seguridad.

Introducción: La evisceración posquirúrgica es una complicación con origen multifactorial.Los estudios para prevenirla modifican la técnica de cierre. La técnica reinforced tensión line (RTL) se ha usado en el tratamiento de hernias incisionales.Material y métodos: Ensayo clínico en pacientes sometidos a laparotomía media. Se formaron dos grupos: 1) control con cierre habitual, y 2) grupo experimental con la técnica RTL. Se evaluó la presencia de evisceración posquirúrgica.Resultados: Terminaron el estudio 89 pacientes. Se presentaron un total de 9 (20 %) y 2 (4.5 %) evisceraciones, con diferencia a favor de la técnica RTL con una p de 0.0273.Conclusiones: Se encontró que la técnica RTL reduce la incidencia de evisceración posquirúrgica.