Short- and Long-Term Outcomes after a Reconstituting and Fenestrating Subtotal Cholecystectomy.

Autor:	van Dijk AH; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands., Donkervoort SC; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Lameris W; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands., de Vries E; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands., Eijsbouts QAJ; Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands., Vrouenraets BC; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Busch OR; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands., Boermeester MA; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands., de Reuver PR; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Philip.deReuver@radboudumc.nl.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2017 Sep; Vol. 225 (3), pp. 371-379. Date of Electronic Publication: 2017 Jun 10.
DOI:	10.1016/j.jamcollsurg.2017.05.016
Abstrakt:	Background: Multiple surgical techniques are recommended to perform cholecystectomy safely in difficult cases, such as conversion to open operation or subtotal cholecystectomy (STC). Reconstituting and fenestrating STC are 2 techniques for STC. The aim of this study was to investigate the short and long-term morbidity and quality of life associated with STC and to compare the outcomes after reconstituting and fenestrating STC. Study Design: Patients who underwent STC were identified. Short-term morbidity assessed included bile leakage, bile duct injury, intra-abdominal infection, reinterventions, and readmittance. Long-term morbidity included bile duct stenosis and recurrent biliary events. Differences in the outcomes of fenestrating and reconstituting STC were assessed. Quality of life was assessed by EuroQol 5 Dimensions, Short-Form 36 Questionnaire, and Gastrointestinal Quality of Life Index questionnaires. Results: Subtotal cholecystectomy was performed in 191 patients, of which 102 (53%) underwent fenestrating STC and 73 (38%) underwent reconstituting STC. Bile leakage was significantly more common after fenestrating STC (18% vs 7%, respectively; p < 0.022). After a median of 6 years follow-up (interquartile range 5 to 10 years), recurrence rate of biliary events was lower after fenestrating than reconstituting STC (9% vs 18%, respectively; p < 0.022). Overall reintervention rate did not differ between the 2 groups: 32% in the fenestrating STC group and 26% in the reconstituting STC group (p = 0.211). Completion cholecystectomy was performed significantly more in patients after fenestrating STC (9% vs 4%; p < 0.022). Conclusions: Subtotal cholecystectomy is a safe and feasible technique for difficult cases for which conversion only will not solve the difficulty of an inflamed hepatocystic triangle. The choice for reconstituting or fenestrating STC depends on intraoperative conditions and both techniques are associated with specific complications. (Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu