Closure of the cystic duct orifice in laparoscopic subtotal cholecystectomy for severe cholecystitis

Matsumura, Tatsuki; Komatsu, Shunichiro; Komaya, Kenichi; Ando, Keiichi; Arikawa, Takashi; Ishiguro, Seiji; Saito, Takuya; Osawa, Tsutomu; Kurahashi, Shintaro; Uchino, Tairin; Yasui, Kohei; Kato, Shoko; Suzuki, Kenta; Kato, Yōkō; Sano, Tsuyoshi

doi:10.1111/ases.12449

Cited by 9 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirty studies (1,418 patients) reported on long-term follow-up. 13 – 15 , 17 , 18 , 20 , 24 , 26 – 30 , 32 , 34 – 37 , 40 – 47 , 50 , 51 , 53 , 54 , 56 The median follow-up period was 22 months. Four deaths occurred in the period after thirty days following surgery.…”

Section: Resultsmentioning

confidence: 99%

A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?

Al‐Azzawi

Abouelazayem

Parmar

et al. 2024

annals

View full text Add to dashboard Cite

Introduction Laparoscopic subtotal cholecystectomy (LSTC) is a bailout procedure that is undertaken when it is not safe to proceed with a laparoscopic total cholecystectomy owing to dense adhesions in Calot’s triangle. The main aim of this review was to investigate the early (≤30 days) and late (>30 days) morbidity and mortality of LSTC. Methods A literature search of the PubMed ® (MEDLINE ® ), Google Scholar™ and Embase ® databases was conducted to identify all studies on LSTC published between 1985 and December 2020. A systematic review was then performed. Results Overall, 45 studies involving 2,166 subtotal cholecystectomy patients (51% female) were identified for inclusion in the review. The mean patient age was 55 years (standard deviation: 15 years). Just over half (53%) of the patients had an elective procedure. The conversion rate was 6.2% ( n =135). The most common indication was acute cholecystitis (49%). Different techniques were used, with the majority having a closed cystic duct/gallbladder stump (71%). The most common closure technique was intracorporeal suturing (53%), followed by endoloop closure (15%). Four patients (0.18%) died within thirty days of surgery. Morbidity within 30 days included bile duct injury (0.23%), bile leak (18%) and intra-abdominal collection (4%). Reoperation was reported in 23 patients (1.2%), most commonly for unresolving intra-abdominal collections and failed endoscopic retrograde cholangiopancreatography to control bile leak. Long-term follow-up was reported in 30 studies, the median follow-up duration being 22 months. Late morbidity included incisional hernias (6%), symptomatic gallstones (4%) and common bile duct stones (2%), with 2% of cases requiring completion of cholecystectomy. Conclusions LSTC is an acceptable alternative in patients with a “difficult” Calot’s triangle.

show abstract

Section: Resultsmentioning

confidence: 99%

A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?

Al‐Azzawi

Abouelazayem

Parmar

et al. 2024

annals

View full text Add to dashboard Cite

show abstract

“…The incidence of bile leakage after SC was reported to be 10–18% [ 9 ]. Compared to open cholecystectomy, SC was reported to result in greater postoperative bile leakage, but lower common bile duct injury, postoperative complications, reoperation, and mortality [ 20 – 22 ]. In this study, bile leakage did not occur in the 15 patients who underwent SC probably because ligation of the cystic duct or suture closure of the residual gallbladder stump was performed in all cases.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis

Katsura

Kanda

et al. 2021

BMC Surg

View full text Add to dashboard Cite

Background Severe adhesions and fibrosis between the posterior wall of the gallbladder and liver bed often render total cholecystectomy after percutaneous transhepatic gallbladder drainage (PTGBD) difficult, leading to high open conversion rates. Since the publication of Tokyo Guidelines 2018 (TG18), our policy has shifted from open conversion to subtotal cholecystectomy (SC) when total laparoscopic cholecystectomy for difficult cases of cholecystitis is not feasible. Recently, SC has been frequently applied as bailout surgery for complicated cholecystitis. Nonetheless, the efficacy and validity of laparoscopic SC after PTGBD remain unclear. This study aimed to evaluate the safety and feasibility of laparoscopic SC after PTGBD for grade II or III acute cholecystitis (AC) by comparing two periods of altered surgical strategies. Methods This retrospective cohort study was conducted between January 2013 and December 2020. A total of 44 eligible patients with grade II or III AC were divided according to the time of cholecystitis onset into the pre-TG18 group (2013–2017, n = 17) and post-TG18 group (2018–2020, n = 27). Patients’ background demographics, surgical method, surgical results, and postoperative complications were compared. Results The interval between PTGBD and surgery was significantly longer in the post-TG18 group than in the pre-TG18 group (15 [interquartile range: 9–42] days vs. 8 [4–11] days; P = 0.010). The frequency of laparoscopic cholecystectomy significantly increased from 52.9% in the pre-TG18 group to 88.9% in the post-TG18 group (P = 0.007), whereas the frequency of SC was 23.5% and 40.7%, respectively, which showed no statistically significant difference (P = 0.241). However, the rate of laparoscopic SC significantly increased from 0 to 90.9% among 15 SC cases, whereas the rate of open SC significantly plummeted from 100 to 9.1% (P = 0.001). Significant differences in the operative time, amount of intraoperative bleeding, and incidence of postoperative complications (wound infection and subhepatic abscess) were not observed. Mortality, bile leakage, and bile duct injury did not occur in either group. Conclusions For grade II or III AC after PTGBD, aggressive adoption of SC increased the completion rate of laparoscopic surgery. Laparoscopic SC is a safe and feasible treatment option.

show abstract

“…Preoperative magnetic resonance cholangio-pancreatography (MRCP) could be very useful for this anatomic entity. There are some reports that recommend MRCP, [7] or CT with drip infusion cholangiography before LC. [8] Our patient had intraabdominal bile collection but she had normal bilirubin levels.…”

Section: Discussionmentioning

confidence: 99%

Posterior Sectoral Biliary Duct Injury During Laparascopic Cholecystectomy: Case Report

Karakas¹

2019

Laparosc Endosc Surg Sci

View full text Add to dashboard Cite

Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45-year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.

show abstract

Closure of the cystic duct orifice in laparoscopic subtotal cholecystectomy for severe cholecystitis

Abstract: These results suggest that LSC with CDOS is a promising approach that can avoid dissection of Calot's triangle and achieve the complete removal of the gallbladder cavity in patients with severe cholecystitis.

Cited by 9 publications

References 17 publications

A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?

A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?

Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis

Posterior Sectoral Biliary Duct Injury During Laparascopic Cholecystectomy: Case Report

Contact Info

Product

Resources

About