Better safe than total; experience of laparoscopic subtotal cholecystectomy in a specialist Upper GI and Bariatric surgery unit and literature review (2019)

Type of publication:
Conference abstract

Author(s):
*Rehman S.; *Abayomi S.; *Jahangir B.; *Maciejewski M.; *Qassem M.; *Kirby G.

Citation:
British Journal of Surgery; Sep 2019; vol. 106, S5; p. 117

Abstract:
Aims: NICE/AUGIS guidelines suggest performing cholecystectomies while ‘hot’ (within a week). There is a
significant risk of biliary injury and/or open procedure in severely inflamed gallbladders and subtotal
cholecystectomies have been suggested to prevent these. The objective of this article is to present short and
medium term outcomes of laparoscopic subtotal cholecystectomy (LSC) in a specialist upper GI and bariatric
unit.
Method(s): This study included all consecutive patients who underwent LSC between August 2014 and August
2018. Clinical notes were retrospectively analysed. Assessed parameters included demographics, urgency of
operation, method of stump closure, length of inpatient stay, biliary injury, post-op incidence of intervention or
re-operation and post-op complications.
Result(s): 20 patients underwent LSC comprising around 0.7% of all the gallbladder operations performed in
our unit during this period. Median age was 67.1 years. 15 (75%) of these operations were carried out as
elective. Stump was closed by absorbable sutures in 18 (90%) of these patients while endoloop was used in one. Median length of stay was 6.2 days. None of the patients had biliary injury on later follow up and 7 (35%)
patients required ERCP. Post-op complications included chronic abdominal pain, wound infection and bile leak
in 2 (10%), 1 (5%) and 1 (5%) patient respectively.
Conclusion(s): Laparoscopic subtotal cholecystectomy proved to have an acceptable profile of safety and
outcomes in our unit and data is comparable with already published literature. Increased incidence of LSC in
elective patients may highlight the significance of establishing a hot gallbladder service.

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