Subtotal cholecystectomy and open total cholecystectomy: alternatives in complicated cholecystitis
| Autor: | Lydia Lam, Daniel Kaplan, Elizabeth Benjamin, Demetrios Demetriades, Garren M I Low, Konstantinos Chouliaras, Daniel Grabo, Kenji Inaba |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Cholecystitis Acute law.invention Postoperative Complications law medicine Humans Cholecystectomy Severe complication Retrospective Studies Common bile duct business.industry General surgery Retrospective cohort study General Medicine Length of Stay Middle Aged medicine.disease Subtotal cholecystectomy Intensive care unit Conversion to Open Surgery Surgery Dissection medicine.anatomical_structure Treatment Outcome Cholecystectomy Laparoscopic Cholecystitis Female business |
| Zdroj: | The American surgeon. 80(10) |
| ISSN: | 1555-9823 |
| Popis: | Subtotal cholecystectomy (SC) is an alternative to open total cholecystectomy (OTC) when variable anatomy or other intraoperative findings preclude safe dissection of Calot's triangle. The objective of this study was to compare the outcomes between SC and OTC in patients with complicated cholecystitis, cases that could not be completed with the original surgical approach and required intraoperative conversion to either SC or OTC. All cases of cholecystectomy converted to SC or OTC from January 2008 to December 2012 were retrospectively identified. Preoperative laboratory values, imaging studies, and clinical demographics were compared between the two groups. The outcome variables analyzed included hospital and intensive care unit length of stay as well as intraoperative complications. In this study, 214 cases of complicated cholecystitis were analyzed; 63 SC and 151 laparoscopic converted to OTC. From the SC group, 46 (73%) were converted to open, 12 (19%) were primary open, and five (8%) were done laparoscopically. There were no statistically significant differences in demographics, preoperative serologic markers, or intraoperative findings ( P > 0.05). Five (3.3%) common bile duct (CBD) injuries occurred in the OTC group, whereas none occurred in the SC group. Overall there were 23 (15.2%) complications in the OTC group and nine (14.3%) in the SC group. The aggregate severe complication rate (CBD injury, vascular injury, gastrointestinal injury) was significantly higher in the OTC group (0.0 to 7.9%, P = 0.036). In conclusion, SC may be considered as a safe alternative in complicated cholecystitis. |
| Databáze: | OpenAIRE |
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