Long-term outcomes after subtotal reconstituting cholecystectomy: A retrospective case series

Köhn, Julia; Trenk, Alexander; Denham, Woody; Linn, John G.; Joehl, Ray; Ujiki, Michael

doi:10.1016/j.amjsurg.2020.01.030

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…Similarly, Kohn et al (2020), reported that no long‐term complication occurred during the median 76 months of follow‐up in their series of six cases who underwent SC 15 . In a meta‐analysis in which 625 patients from 15 studies were evaluated, four (2.2%) patients presented with recurrent stone causing right upper quadrant pain and eight (2.7%) patients needed re‐operation 34 .…”

Section: Discussionmentioning

confidence: 93%

“…bile leak/fistula, surgical site infection [SSI], hemorrhage, subhepatic collection, retained gallstones, stump cholecystitis, necessity of postoperative endoscopic retrograde cholangiopancreatography [ERCP] and re‐operation) and mortality were not superior to TC 10‐13 . Therefore, SC is never the first choice unless it is mandatory, but is still a bail‐out procedure that remains current in difficult cholecystectomies 14,15 …”

Section: Introductionmentioning

confidence: 99%

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Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Acar

Sür

et al. 2020

J Hepato Biliary Pancreat

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Background Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. Methods Fifty‐seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. Results Thirty‐three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29‐86). All patients had at least one episode of cholecystitis. Forty‐seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow‐up of 49 months (range: 13‐98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. Conclusions Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Acar

Sür

et al. 2020

J Hepato Biliary Pancreat

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“…It is more common to see neostone formation and recurrent biliary disease after reconstituting procedures than after fenestrating procedures. While the completion rates were higher for fenestrating cholecystectomy in a published series, retrospective analysis of the reconstituting technique revealed no long-term recurrent symptoms in six cases [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy

Yıldırım¹,

Zeren²,

Ekici³

et al. 2022

Cureus

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Cholecystectomy is one of the most frequently performed surgeries. Although laparoscopy is considered the gold standard approach, it cannot prevent biliary injuries. Subtotal cholecystectomy has been performed mainly to prevent biliary injuries during difficult cholecystectomies. This study aimed to analyse our subtotal cholecystectomy results for difficult cholecystectomy cases and to evaluate the fenestrating and reconstituting techniques. MethodsRetrospective data were collected and analysed statistically for cases that underwent subtotal cholecystectomy in a single referral centre between 2015 and 2020. Comparisons were made of the patients' age, gender, preoperative American Society of Anaesthesiologists (ASA) score, comorbidities, surgical timing, surgical procedure choice, postoperative complications, and mortality. ResultsThe number of patients who underwent subtotal cholecystectomy was 46; 30.4% underwent emergent surgery and 69.6% underwent elective surgery. Twelve patients had subtotal fenestrating cholecystectomy and 34 had subtotal reconstituting cholecystectomy. Wound issues were noted in 17.4% of the patients, while 10.9% had temporary biliary fistulas that resolved spontaneously. Reoperation was performed in one patient due to high-output biliary drainage. Patients with postoperative complications had significantly higher co-morbid conditions (p=0.000), but surgery timing (p=0.192) and type of subtotal cholecystectomy (p=0.409) had no statistically significant effect on complications. Mortality showed a statistically significant correlation with patient comorbidities, surgery timing, and the type of procedure (p<0.05). Postoperative complications showed a statistically significant correlation with mortality (p<0.05). ConclusionSubtotal cholecystectomy prevents major biliary complications after cholecystectomy. Yet, the frequency of postoperative complications after subtotal cholecystectomy is incontrovertible. Intraoperative characteristics and the surgeon's expertise decide the optimal choice of the subtotal cholecystectomy technique.

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“…For the spinal projection of 5-HT-ergic neurons, Sagalajev et al (2017) explored some interesting findings in a pharmacological study involving the microinjection of NT in the RVM, which resulted in reduced ON cell discharge and facilitated OFF cell activation, thus inducing antinociceptive effects (Buhler et al, 2005). Meanwhile, injection of EM-2 into the RVM activated MOR in spinal projection of 5-HTergic neurons and increased descending 5-HTergic facilitatory influences, although these descending 5-HTergic projections were neither necessary nor sufficient for RVM MOR-or KOR-mediated modulation of descending pain in acute pain conditions (Gu and Wessendorf, 2007;Chen and Heinricher, 2019a;Kohn et al, 2020). Hence, it is reasonable that under physiological conditions, activation of RVM 5-HTergic neurons will inhibit spinal nociceptive neurotransmission.…”

Section: Neurotransmitters Mediating Rvmdriven Descending Modulationmentioning

confidence: 99%

“…Microinjecting the GABA A receptor antagonist bicuculline into vlPAG, the spontaneous activity of OFF cells increased while that of ON cells decreased, resulting in pain inhibition ( Moreau and Fields, 1986 ). When exposed to repeated restraint stress, GABA release into the RVM was increased, facilitating ON cells activity and inhibiting OFF cells activity, hence leading to mechanical hypersensitivity ( Kohn et al, 2020 ). Several studies have suggested that GABA plays a major role in opioid and cannabinoid induced analgesia through the PAG-RVM pathway and is discussed below.…”

Section: Neural Circuits and Neurotransmitters Modulating Rvm On And ...mentioning

confidence: 99%

Bulbospinal nociceptive ON and OFF cells related neural circuits and transmitters

et al. 2023

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The rostral ventromedial medulla (RVM) is a bulbospinal nuclei in the descending pain modulation system, and directly affects spinal nociceptive transmission through pronociceptive ON cells and antinociceptive OFF cells in this area. The functional status of ON and OFF neurons play a pivotal role in pain chronification. As distinct pain modulative information converges in the RVM and affects ON and OFF cell excitability, neural circuits and transmitters correlated to RVM need to be defined for an in-depth understanding of central-mediated pain sensitivity. In this review, neural circuits including the role of the periaqueductal gray, locus coeruleus, parabrachial complex, hypothalamus, amygdala input to the RVM, and RVM output to the spinal dorsal horn are discussed. Meanwhile, the role of neurotransmitters is concluded, including serotonin, opioids, amino acids, cannabinoids, TRPV1, substance P and cholecystokinin, and their dynamic impact on both ON and OFF cell activities in modulating pain transmission. Via clarifying potential specific receptors of ON and OFF cells, more targeted therapies can be raised to generate pain relief for patients who suffer from chronic pain.

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Long-term outcomes after subtotal reconstituting cholecystectomy: A retrospective case series

Cited by 15 publications

References 17 publications

Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy

Bulbospinal nociceptive ON and OFF cells related neural circuits and transmitters

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