Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Frequency, Complications, and Predictive Factors for

Performing Subtotal Laparoscopic Cholecystectomy in a

Hepatobiliary Unit: A Comparative Cohort Study

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Alexia Farrugia , Niranjan Ravichandran , Majid Ali , Harry Blege , Saboor Khan , For Tai Lam , Jawad Ahmad ,
Gabriele Marangoni 8
AbstrAct
Aims: Laparoscopic subtotal cholecystectomies (LSCs) are occasionally performed for difficult gallbladder (GB) surgery. The aim of this study
is to determine the rate, complications, and factors predictive of performing LSC in a hepatobiliary (HPB) unit, in comparison to patients who
have undergone a conventional operation.
Materials and methods: A 5-year retrospective review of laparoscopic cholecystectomies (LCs) was performed by HPB team at a tertiary center.
Demographic, operative, and postoperative data were identified. A randomized group (generated using online randomization software Research
Randomizer®) of LC patients was identified from the study cohort, who had the same data recorded for comparison. Significance level was set
at p < 0.05 when comparing the two groups of LC and LSC.
Results: A total of 1,613 patients underwent LC, of which, 102 (6.3%) underwent LSC. The complication rate was 12.7% in the LSC group, mainly
consisting of bile leak (3.9%) and collection requiring drainage (0.98%). The LC group had a 4.9% complication rate, of which, one bile leak was
reported, i.e., 1 (0.98%). The length of stay was significantly longer in the LSC group (2 days vs 0 days in the LC group), and this group also had a
slightly higher readmission rate (8.8% vs 3.92%). Laparoscopic subtotal cholecystectomy was found to be more likely in patients with previous
cholecystitis, thickened GB wall on imaging and previous endoscopic retrograde cholangiopancreatography (ERCP).
Conclusion: Laparoscopic subtotal cholecystectomy is a safe procedure and the above characteristics may be used to potentially predict who is
more likely to undergo LSC. This may aid in the consenting process and also help to create a score that predicts the probability of undergoing LSC.
Keywords: Gallbladder, Laparoscopic cholecystectomy, Predictive factors, Subtotal cholecystectomy.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1369

IntroductIon 1 Department of HPB Surgery, University Hospitals Coventry and
Since the 1980s, LC has been the gold standard procedure to Warwickshire, Coventry, West Midlands, UK
treat benign gallbladder (GB) disease. This allows for a shorter 2–8 Department of Surgery, University Hospitals Coventry and
hospital stay and operating time as well as quicker postoperative Warwickshire, Coventry, West Midlands, UK
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rehabilitation and lower wound infection rates. However, in Corresponding Author: Gabriele Marangoni, Department of Surgery,
some cases, such as adhesion, fibrosis, Mirizzi’s syndrome, biliary University Hospitals Coventry and Warwickshire, Coventry, West
anomalies, empyema of the GB, or gangrene, dissection of Calot’s Midlands, UK, Phone: +44 2476965269, e-mail: Gabriele.marangoni@
triangle may be very difficult. Previously, this used to be dealt with uhcw.nhs.uk
by converting to an open procedure, which prolongs hospital stay How to cite this article: Farrugia A, Ravichandran N, Ali M, et al.
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and could be associated with higher complication rates. This led Frequency, Complications, and Predictive Factors for Performing
to the development of laparoscopic cholecystectomies (LSC), which Subtotal Laparoscopic Cholecystectomy in a Hepatobiliary Unit:
may be attempted to avoid injury to the bile ducts and, therefore, A Comparative Cohort Study. World J Lap Surg 2019;12(2):53–55.

allow a difficult cholecystectomy to still be done as a day-case Source of support: Nil
procedure or potentially with only overnight stay. 3,4 Conflict of interest: None
There are several ways to perform LSC. One method is to excise
the anterior wall of the GB with stone extraction and leave the
posterior wall attached to the liver. Another method is fundus-first the rate of LSC and its associated complications in a HPB unit and
excision of the GB followed by division at the Hartmann’s pouch. also to determine the predictive factors for performing LSC, if any.
The cystic duct stump can be either left open or closed using
endoloop, an intracorporeal stitch, or stapled. The mucosa of the MAterIAls And Methods

posterior wall of the remnant GB is diathermied or left alone with
or without a drain in situ. 5 The study was registered with the local authorities (audit
The LSC has been shown to reduce the need for conversion number 215). All patients who underwent LC between 2013 and 2017
to an open procedure, thus reducing the length of stay and other at a tertiary center were retrospectively reviewed to determine the
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complications associated with the open cholecystectomy. Studies frequency of LSC. The data for the initial patient cohort was obtained
have also shown that this procedure decreases the bile duct injury from the hospital coding team, and patients who underwent LSC
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rate 3,7–9 and is safe in cirrhotic patients. The aim was to determine were extracted from the operation notes. The inclusion criteria were
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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