Laparoscopic Subtotal Cholecystectomy after Grade II or III Cholecystitis via Percutaneous Transhepatic draining of the Gallbladder
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Abstract
Background: Subtotal cholecystectomy is indicated in certain circumstances when it is challenging to identify the anatomical gallbladder structures or if there is a high risk of iatrogenic damage. For acute calculous cholecystitis, the 2020 World Journal of Emergency Surgery recommends subtotal cholecystectomy. Intraoperative cholangiography, conversion to open surgery, aborting the process, and subtotal cholecystectomy are examples of possible bail-out techniques that can be performed during problematic cholecystectomy, especially after percutaneous drainage. Subtotal cholecystectomy is considered the best backup plan when a critical view of safety cannot be achieved during a challenging cholecystectomy.
Objective: This study aimed to assess the effectiveness and accessibility of laparoscopic SC after PTGBD for Grade II or III acute cholecystitis patients.
Methods: The time frame for this retrospective study spans from December 2014 to January 2022. Based on the appearance of cholecystitis, 88 patients with degree II or III AC were divided into pre-TG18 (2014–2018, n = 34) and post-TG18 (2018–2022, n = 54) groups. We examined the patients’ demographic backgrounds, surgical methods, and postoperative outcomes.
Results: The duration of PTGBD was significantly longer in the post-TG18 group (15 [interquartile range–9-42] days vs. 8 [4-11] days). The prevalence of laparoscopic cholecystectomy significantly increased to 52.9% in the study population before TG18 and to 88.9% in the group after TG18 (p = 0.001), in contrast to the SC rates, which were 23.5% and 40.7%, respectively, and did not vary significantly (p = 0.241). Among the 15 SC patients, the proportion of laparoscopic SC patients increased from 0 to 90.9%, while the proportion of open SC patients decreased noticeably, dropping from 100 to 9.1% (p = 0.001). There were no appreciable changes in the length of the operation, quantity of intraoperative bleeding, or frequency of complications following surgery (subhepatic abscess and wound infection). There were no deaths, bile leaks, or bile duct injuries in any of the groups.
Conclusion: Strong support for SC enhanced the success rate of laparoscopic surgery for Grade II or III AC after PTGBD. Thus, laparoscopic SC is safe and practical.
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