Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 166] Subtotal Laparoscopic Cholecystectomy: a Safe And Effective Strategy for Managing Difficult Gallbladder Cases in Acute Cholecystitis
Sarinya PURANAPANYA 1, Nattawut KEERATIBHARAT 1, Sirada PATCHARANARUMOL 2
1 Surgery, School of Surgery, Institute of Medicine, Suranaree University of Technology, THAILAND, 2 Surgery, Department of Surgery, Suranaree University of Technology Hospital, THAILAND
Background : Subtotal laparoscopic cholecystectomy (SLC) serves as an alternative to total laparoscopic cholecystectomy (LC) in challenging gallbladder cases or when the critical view of safety (CVS) is unattainable. This study aimed to identify predictive factors and compare outcomes between SLC and LC.
Methods : Clinical data from patients diagnosed with acute cholecystitis undergoing SLC and LC between October 2018 and October 2023 were gathered and analyzed using Wilcoxon rank-sum and Fisher's exact tests.
Results : The study encompassed 109 LCs and 35 SLCs. Patients undergoing SLC exhibited a higher prevalence of conditions such as Empyema or gangrenous gallbladder (28.6% vs 11%, p=0.02), endured longer hospital stays (7 days vs 4 days, p-value less than 0.001), and experienced greater intraoperative blood loss (30 ml vs 10 ml, p=0.009). However, operative times were comparable between the groups (p=0.09). Notably, the SLC group had a higher incidence of bile leak (28.6% vs 1.8%, p-value less than 0.001) and recurrent cholecystitis (p=0.006). Among those with postoperative bile leaks, conservative management was successful in 91.7% of cases, with the remainder requiring ERCP. Remarkably, no biliary or vascular injuries were reported in either group.
Conclusions : SLC, despite more complex biliary disease markers and challenging operative courses, shows promise as a safe option for difficult gallbladder cases or when achieving CVS is not feasible, evidenced by the absence of biliary or vascular injuries.
Methods : Clinical data from patients diagnosed with acute cholecystitis undergoing SLC and LC between October 2018 and October 2023 were gathered and analyzed using Wilcoxon rank-sum and Fisher's exact tests.
Results : The study encompassed 109 LCs and 35 SLCs. Patients undergoing SLC exhibited a higher prevalence of conditions such as Empyema or gangrenous gallbladder (28.6% vs 11%, p=0.02), endured longer hospital stays (7 days vs 4 days, p-value less than 0.001), and experienced greater intraoperative blood loss (30 ml vs 10 ml, p=0.009). However, operative times were comparable between the groups (p=0.09). Notably, the SLC group had a higher incidence of bile leak (28.6% vs 1.8%, p-value less than 0.001) and recurrent cholecystitis (p=0.006). Among those with postoperative bile leaks, conservative management was successful in 91.7% of cases, with the remainder requiring ERCP. Remarkably, no biliary or vascular injuries were reported in either group.
Conclusions : SLC, despite more complex biliary disease markers and challenging operative courses, shows promise as a safe option for difficult gallbladder cases or when achieving CVS is not feasible, evidenced by the absence of biliary or vascular injuries.
SESSION
E-poster
E-Session 03/21 ALL DAY