Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy—a systematic review

Springer Science and Business Media LLC - Tập 16 Số 1 - 2021
Adriana Toro1, Michele Teodoro2, Mansoor A. Khan3, Elena Schembari4, Salomone Di Saverio5, Fausto Catena6, Isidoro Di Carlo7
1General Surgery, Augusta Hospital, Siracusa, Italy
2Department of Emergency, S. Marco Hospital, Catania, Italy
3Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
4Department of General Surgery, Whipps Cross University Hospital-Barts Health NHS Trust, , London, UK
5General Surgery, University of Insubria, Varese, Italy
6Emergency and Trauma Surgery, Parma Maggiore Hospital, Parma, Italy
7Department of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Cannizzaro Hospital, University of Catania, Via Messina 829, 95126, Catania, Italy

Tóm tắt

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.

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Tập 16 Số 1

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