A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study

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A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis : A multicenter real-world study

Dhanasekara, Chathurika S. (författare): Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

Shrestha, Kripa (författare): Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

Grossman, Holly (författare): Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

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Garcia, Liza M. (författare): Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

Maqbool, Baila (författare): Department of Surgery, University of New Mexico, Albuquerque, NM, USA

Luppens, Carolyn (författare): Department of Surgery, University of New Mexico, Albuquerque, NM, USA

Dumas, Ryan P. (författare): Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Taveras Morales, Luis R. (författare): Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

Brahmbhatt, Tejal Sudhirkumar (författare): Department of Surgery, Boston Medical Center, Boston, MA, USA

Haqqani, Maha (författare): Department of Surgery, Boston Medical Center, Boston, MA, USA

Lunevicius, Raimundas (författare): Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

Nzenwa, Ikemsinachi C. (författare): Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Department of Surgery, Massachusetts General Hospital, MA, USA

Griffiths, Ewen (författare): Queen Elizabeth Hospital, University Hospitals NHS Foundation Trust, Edgbaston, Birmingham, UK

Almonib, Ahmed (författare): Queen Elizabeth Hospital, University Hospitals NHS Foundation Trust, Edgbaston, Birmingham, UK

Bradley, Nori L. (författare): Department of Surgery, University of Alberta, Canada

Lerner, E. Paul (författare): Department of Surgery, University of Alberta, Canada

Mohseni, Shahin, 1978- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, UAE; School of Medical Sciences, Orebro University, Sweden

Trivedi, Dhanisha (författare): Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, UAE

Joseph, Bellal A. (författare): Department of Surgery, University of Arizona, Tucson, AZ, USA

Anand, Tanya (författare): Department of Surgery, University of Arizona, Tucson, AZ, USA

Plevin, Rebecca (författare): Department of Surgery, University of California San Francisco, CA, USA

Nahmias, Jeffry T. (författare): Department of Surgery, University of California, Irvine, Orange, CA, USA

Lasso, Erika Tay (författare): Department of Surgery, University of California, Irvine, Orange, CA, USA

Dissanaike, Sharmila (författare): Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

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2024
2024
Engelska.
Ingår i: Surgery. - : Elsevier. - 0039-6060 .- 1532-7361.

Relaterad länk:: https://urn.kb.se/re...; visa fler...; https://doi.org/10.1...; visa färre...

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BACKGROUND: Dense inflammation obscuring the hepatocystic anatomy can hinder the ability to perform a safe standard laparoscopic cholecystectomy in severe cholecystitis, requiring use of a bailout procedure. We compared clinical outcomes of laparoscopic and open subtotal cholecystectomy against the traditional standard of open total cholecystectomy to identify the optimal bailout strategy for the difficult gallbladder.METHODS: A multicenter, multinational retrospective cohort study of patients who underwent bailout procedures for severe cholecystitis. Procedures were compared using one-way analysis of variance/Kruskal-Wallis tests and χ2 tests with multiple pairwise comparisons, maintaining a family-wise error rate at 0.05. Multiple multivariate linear/logistical regression models were created.RESULTS: In 11 centers, 727 bailout procedures were conducted: 317 laparoscopic subtotal cholecystectomies, 172 open subtotal cholecystectomies, and 238 open cholecystectomies. Baseline characteristics were similar among subgroups. Bile leak was common in laparoscopic and open fenestrating subtotal cholecystectomies, with increased intraoperative drain placements and postoperative endoscopic retrograde cholangiopancreatography(P < .05). In contrast, intraoperative bleeding (odds ratio = 3.71 [1.9, 7.22]), surgical site infection (odds ratio = 2.41 [1.09, 5.3]), intensive care unit admission (odds ratio = 2.65 [1.51, 4.63]), and length of stay (Δ = 2 days, P < .001) were higher in open procedures. Reoperation rates were higher for open reconstituting subtotal cholecystectomies (odds ratio = 3.43 [1.03, 11.44]) than other subtypes. The overall rate of bile duct injury was 1.1% and was not statistically different between groups. Laparoscopic subtotal cholecystectomy had a bile duct injury rate of 0.63%.CONCLUSION: Laparoscopic subtotal cholecystectomy is a feasible surgical bailout procedure in cases of severe cholecystitis where standard laparoscopic cholecystectomy may carry undue risk of bile duct injury. Open cholecystectomy remains a reasonable option.

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A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis : A multicenter real-world study

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