Subtotal cholecystectomy: a case series
DOI:
https://doi.org/10.18203/2349-2902.isj20242452Keywords:
Bile leak, Cholecyctectomy, Difficult gall bladder, Fenestration, Nassar scale, Reconstituting, Subtotal cholecystectomyAbstract
Subtotal cholecystectomy is a method of removing most of the gallbladder instead of whole of the gallbladder in case of a difficult gallbladder. The term “subtotal cholecystectomy” was introduced by Morse and Barb. Subtotal cholecystectomy is a bailout procedure undertaken in situations where the anatomical structures are not easy to identify making total cholecystectomy difficult and risky. We have done twelve cases from June 2019 to June 2024, while performing laparoscopic cholecystectomy as we could not continue, due to risk of injury and complications. Post-operatively there were some cases of mild bile leak, but no serious complications. All cases belong to Nassar scale grade 3 and 4. Here we are describing how and when subtotal cholecystectomy should be done.
References
Salky BA, Edye MB. The difficult Cholecystectomy: problems related to concomitant diseases. Semin Laparosc Surg. 1998;5(2):107-14.
Laws HL. The difficult cholecystectomy problems during dissection and extraction Semin Laparosc Surg. 1998;5(2):81-91.
Strasberg SM. A three-step conceptual roadmap for avoiding bile and injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci. 2019;26(4):123-7.
Srinivasa S, Hammill CW, Strasberg SM. How to do laparosopic subtotal fenestrated cholecystectomy. ANZ J. Surg. 2021;91(4):740-1.
Ramirez-Giraldo C, Torres-Gullar A, Van-Londono I. Sate of the art in subtotal cholecystectomy: An overview. Front Surg. 2023;21.
Schein M, Rogers PN, Assalia A, Lane R. Schein’s Common Sense Emergency Abdominal surgery. Springer. 2010;3:192.
Henneman D, daCosta DW, Vrounracts BC, Van Wagensveld BA, Lagarde SM. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc. 2013;27(2):351-8.
Sanders G, Kingsnorth AN. Gallstones. BMJ. 2007;335(7614):295-9.
Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut. 1989;30(2):201-5.
Bansal A, Akhtar M, Bansal AK. A clinical study: prevalence and management of cholelithiasis. Int Surg J. 2014;1:134-9.
Mhamunkar SR, Bapat RD, Mahadik SP, Abhyankar BA. Epidemiological study of cholelithiasis. Int Surg J. 2014;1(3):138.
Pisano M, Allievi N, Gurusami K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World society of emergency surgery updated guidelines for the diagnosis and treatment of acute calculous cholecystitis. World J Emerg Surg. 2020;15(1):1-26.
Griffiths EA, Hodson J, Vohra RS, Marriott P, The Choles Study Group, Ketheb T, et al. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc. 2018;33(1):122.
Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystectomy to cholelithiasis. Cochrane Database Syst Rev. 2006;(4):CD00623.
Lunevicins R. Review of the literature on Partial Resection of the Gallbladder, 1998-2022: The outline of the Conception of Subtotal Cholecystectomy and a Suggestion to use the Term Subtotal Open-Tract Cholecystectomy and Subtotal Closed – Tract Cholecystectomy. J Clin Med. 2023;12(3):1230.
Bornmann PC, Torblanche J. Subtotal cholecystectomy: for the difficult gallbladder in portal hypertension and cholecystitis. Surgery. 1985;98:1-6.
Michalowski K, Bornmann PC, Krige JE, Gallagher PJ, Terblandu J. Laparoscopic subtotal cholecystectomy in patients with chomplicated acute cholecystitis or birosis. Br J Surg. 1998;85:904-6.
Gallstones and laparoscopic cholecystectomy. NIH Consensus Statement. 1992;10(3):1-28.
Silverstein A, Costas-Chavarze A, Gakewaya MR, Lule J, Mulchopadhyay S, Meara JG, et al. Laparosopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at Rawanda Military Hospital. World J Surg. 2017;41(5):1225-33.
Maclani TD, Nakonezny PA, Imran JB, Taveras L, Cunningham HB, Vela R, et al. A comparison of cholecystitis garding scales. J. Trauma Acute Care Surg. 2019;86(3):471-8.
Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003;290(16):2168-73.
Azzawi MA, Abouelazayem M, Parmar C, Singhal R, Amr B, Martinino A, et al. A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladder: a life saving bail out or an incomplete operation? Ann R Coll Surg Engl. 2024;106(3):205-12.
Firgger R. Challenging situation in cholecystectomy and strategies to overcome them. Eur Surg. 2021;53:106-33.
Eikermann M, Siegel R, Broeders I, Dziri C, Fingerhut A, Gutt C, et al; European Association for Endoscopic Surgery. Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2012;26(11):3003-39.
Strasberg SM, Pucci MJ, David DJ, Brunt LM. Subtotal cholecystectomy fenestrating reconstituting subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg. 2016;222(1):89-96.