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 cholecystect...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-021-00392-x |
| _version_ | 1819094539754799104 |
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| author | Adriana Toro Michele Teodoro Mansoor Khan Elena Schembari Salomone Di Saverio Fausto Catena Isidoro Di Carlo |
| author_facet | Adriana Toro Michele Teodoro Mansoor Khan Elena Schembari Salomone Di Saverio Fausto Catena Isidoro Di Carlo |
| author_sort | Adriana Toro |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T23:29:01Z |
| format | Article |
| id | doaj.art-ae06e1e21ff54f879612f71e78264a61 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-21T23:29:01Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-ae06e1e21ff54f879612f71e78264a612022-12-21T18:46:33ZengBMCWorld Journal of Emergency Surgery1749-79222021-09-0116111010.1186/s13017-021-00392-xSubtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic reviewAdriana Toro0Michele Teodoro1Mansoor Khan2Elena Schembari3Salomone Di Saverio4Fausto Catena5Isidoro Di Carlo6General Surgery, Augusta HospitalDepartment of Emergency, S. Marco HospitalBrighton and Sussex University Hospitals NHS TrustDepartment of General Surgery, Whipps Cross University Hospital-Barts Health NHS TrustGeneral Surgery, University of InsubriaEmergency and Trauma Surgery, Parma Maggiore HospitalDepartment of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Cannizzaro Hospital, University of CataniaAbstract 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.https://doi.org/10.1186/s13017-021-00392-xGallbladderDifficulty cholecystectomyLaparoscopic subtotal cholecystectomyComplicationsClavien–Dindo classification |
| spellingShingle | Adriana Toro Michele Teodoro Mansoor Khan Elena Schembari Salomone Di Saverio Fausto Catena Isidoro Di Carlo Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review World Journal of Emergency Surgery Gallbladder Difficulty cholecystectomy Laparoscopic subtotal cholecystectomy Complications Clavien–Dindo classification |
| title | Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review |
| title_full | Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review |
| title_fullStr | Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review |
| title_full_unstemmed | Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review |
| title_short | Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review |
| title_sort | subtotal cholecystectomy for difficult acute cholecystitis how to finalize safely by laparoscopy a systematic review |
| topic | Gallbladder Difficulty cholecystectomy Laparoscopic subtotal cholecystectomy Complications Clavien–Dindo classification |
| url | https://doi.org/10.1186/s13017-021-00392-x |
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