Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis

Sabour, Andrew F.; Matsushima, Kazuhide; Love, Bryan; Alicuben, Evan T.; Schellenberg, Morgan; Inaba, Kenji; Δημητριάδης, Δημήτριος

doi:10.1016/j.surg.2019.11.004

Cited by 64 publications

(46 citation statements)

References 14 publications

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“…The conversion rate from laparoscopic to open total cholecystectomy decreased from 10.5 to 7.6%. Interestingly, the teaching hospitals significantly increased the rate of subtotal cholecystectomy [99]. Furthermore, it should be highlighted that there are different techniques to achieve subtotal cholecystectomy: this aspect could add some difficulty in analysing data from different studies [100].…”

Section: Patients Who Are Pregnantmentioning

confidence: 99%

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

et al. 2020

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Background Acute calculus cholecystitis (ACC) has a high incidence in the general population. The presence of several areas of uncertainty, along with the availability of new evidence, prompted the current update of the 2016 WSES (World Society of Emergency Surgery) Guidelines on ACC. Materials and methods The WSES president appointed four members as a scientific secretariat, four members as an organization committee and four members as a scientific committee, choosing them from the expert affiliates of WSES. Relevant key questions were constructed, and the task force produced drafts of each section based on the best scientific evidence from PubMed and EMBASE Library; recommendations were developed in order to answer these key questions. The quality of evidence and strength of recommendations were reviewed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria (see https://www.gradeworkinggroup.org/). All the statements were presented, discussed and voted upon during the Consensus Conference at the 6th World Congress of the World Society of Emergency Surgery held in Nijmegen (NL) in May 2019. A revised version of the statements was voted upon via an online questionnaire until consensus was reached. Results The pivotal role of surgery is confirmed, including in high-risk patients. When compared with the WSES 2016 guidelines, the role of gallbladder drainage is reduced, despite the considerable technical improvements available. Early laparoscopic cholecystectomy (ELC) should be the standard of care whenever possible, even in subgroups of patients who are considered fragile, such as the elderly; those with cardiac disease, renal disease and cirrhosis; or those who are generally at high risk for surgery. Subtotal cholecystectomy is safe and represents a valuable option in cases of difficult gallbladder removal. Conclusions, knowledge gaps and research recommendations ELC has a central role in the management of patients with ACC. The value of surgical treatment for high-risk patients should lead to a distinction between high-risk patients and patients who are not suitable for surgery. Further evidence on the role of clinical judgement and the use of clinical scores as adjunctive tools to guide treatment of high-risk patients and patients who are not suitable for surgery is required. The development of local policies for safe laparoscopic cholecystectomy is recommended.

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Section: Patients Who Are Pregnantmentioning

confidence: 99%

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

et al. 2020

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“…A study from the National Inpatient Sample reported that the rate of laparoscopic subtotal cholecystectomy increased from 0.12 % of all cholecystectomies in 2003 to 0.28 % in 2014, and the rate of open subtotal cholecystectomy increased from 0.10 % to 0.52 % within the same timeframe. Factors associated with likelihood of subtotal cholecystectomy in this study included male sex, Asian American ethnicity, surgery performed in a teaching hospital, and surgery performed in a rural location [12]. ERCP with biliary stent placement is first-line therapy for treatment of bile leaks following cholecystectomy.…”

Section: Discussionmentioning

confidence: 98%

Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

2020

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Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy. Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP). Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87 % of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13 % (8/61). Leak resolution was evident at first follow-up ERCP in 96 % of subjects (26/27) who had undergone total cholecystectomy and 91 % of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96 % (23/24) of those who had undergone total cholecystectomy and 90 % (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62). Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.

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“…The mean operative time, the median hospital length of stay, cost, and mortality rates increase in SC compared to TC due to the increased complication rates, technical difficulties of the procedure and the patients’ poor general condition 6,27,34,37,38 . However, long‐term quality of life does not differ 23…”

Section: Discussionmentioning

confidence: 99%

“…inflamed gallbladders [GB] with higher Nassar scores, 3 fibrosis, adhesions, obesity, and technical difficulty) 4 . Therefore, procedures that have been understood to be safer, such as percutaneous cholecystostomy, or as an alternative method, such as subtotal cholecystectomy (SC), can be performed in “difficult‐GBs,” or integrity of the biliary tract can be checked with intraoperative cholangiography 5,6 …”

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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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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Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis

Cited by 64 publications

References 14 publications

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis

Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

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

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