Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Abstract

Background Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. Patients and methods A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Results Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. Conclusion In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

Defining Critical View of Safety During Laparoscopic Cholecystectomy: The Preoperative Predictors of Failure

“…However, due to the lack of expertise and equipment, these techniques were not used at our center. Recently, laparoscopic subtotal cholecystectomy has been widely adopted as the preferred salvage technique in difficult cases [19,20]. However, it is associated with significant risk of postoperative bile leak and residual stones in remnant GB [21].…”

Laparoscopic subtotal reconstituting cholecystectomy in type II & III Mirizzi syndrome: Case series of 5 patients

“…LSRC, as laparoscopic subtotal “fenestrating” cholecystectomy, had recently been proposed as safe (without biliary injury) and effective (single surgery to solve MS) techniques for difficult operative conditions [3] , [4] , [12] , [13] . There are no studies comparing both techniques in MS Type II & III, but evidence show both procedures prevents conversion and has fewer serious complications [14] , [15] , [16] , [17] .…”

State of the art in subtotal cholecystectomy: An overview

“…In another systematic review published in 2021 where both techniques were also compared fenestrating subtotal cholecystectomies were associated to bile leakage rates of 8.52% while reconstituting types had rates of 3.67%, being this the most frequent complication during subtotal cholecystectomies (8).…”