Perioperative strategies for patients undergoing subtotal cholecystectomy: a single-center retrospective review of 102 procedures.

Autor:	Fasting MH; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway., Strønen E; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway., Glomsaker T; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway., Søvik TT; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway., Fyhn TJ; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway., Mala T; Department of Gastrointestinal Surgery, Oslo University Hospital Ullevål, Oslo, Norway.; University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	Scandinavian journal of gastroenterology [Scand J Gastroenterol] 2024 Apr; Vol. 59 (4), pp. 456-460. Date of Electronic Publication: 2023 Dec 05.
DOI:	10.1080/00365521.2023.2289352
Abstrakt:	Background: Calculous gall bladder disease is often handled by laparoscopic cholecystectomy. In cases where a safe dissection of the hepatocystic triangle cannot be carried out, a subtotal cholecystectomy (STC) may be performed. The perioperative management of patients undergoing STC is characterized by limited evidence. This large single-center series explores some of the perioperative aspects and outcomes after STC. Materials and Methods: The study population includes all patients who underwent STC at Oslo University Hospital (Ullevål and Aker Hospitals) from 01.01.2014 to 30.09.2020. A STC was defined as a cholecystectomy where there was a failure to control the cystic duct during surgery. Study variables included demographic data, comorbidities, previous biliopancreatic disease, indication for surgery, perioperative information, subsequent interventions and outcome data. Results: During the study period, 2376 cholecystectomies were performed, and 102 (4.3%) were categorized as STC. Of all patients with STC, 48 (47.1%) had an intra- or postoperative ERCP during the index hospital admission. The indication for ERCP was bile leak in 37 (42.6%) of the cases. The bile leak resolution rate was 60.0 % in intraoperative ERCP vs 95.7% in postoperative ERCP. Among the STC patients, there were no injuries to the central bile ducts. Later, one patient has undergone a remnant cholecystectomy, following fenestrating STC. Conclusion: STC was a safe bailout strategy for dissection in the hepatocystic triangle in difficult cholecystectomies. Intraoperative ERCP increased procedure time and was associated with a lower rate of leak resolution, as compared to postoperative ERCP.
Databáze:	MEDLINE
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