دورية أكاديمية
Laparoscopic subtotal cholecystectomy for the difficult gallbladder: Evolution of technique at a single teaching hospital.
| العنوان: | Laparoscopic subtotal cholecystectomy for the difficult gallbladder: Evolution of technique at a single teaching hospital. |
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| المؤلفون: | Deng SX; Division of General Surgery, University of Toronto, Toronto, ON Canada., Sharma BT; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Ebeye T; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Samman A; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Zulfiqar A; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Greene B; Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada., Tsang ME; Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada., Jayaraman S; Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, ON, Canada. Electronic address: shiva.jayaraman@unityhealth.to. |
| المصدر: | Surgery [Surgery] 2024 Apr; Vol. 175 (4), pp. 955-962. Date of Electronic Publication: 2024 Feb 06. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| مواضيع طبية MeSH: | Cholecystectomy, Laparoscopic*/adverse effects , Cholecystectomy, Laparoscopic*/methods , Cholecystitis*/surgery , Abdominal Injuries*/surgery, Humans ; Retrospective Studies ; Cholecystectomy/methods ; Hospitals, Teaching ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery |
| مستخلص: | Background: We have developed an algorithmic approach to laparoscopic cholecystectomy, including subtotal cholecystectomy, as a bailout strategy when the Critical View of Safety cannot be safely achieved due to significant inflammation and fibrosis of the hepatocystic triangle. Methods: This is a retrospective cohort study comparing postoperative outcomes in patients with severe cholecystitis who underwent laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy at St. Joseph's Health Centre from May 2016 to July 2021, as well as against a historical cohort. We further stratified laparoscopic subtotal cholecystectomy cases based on fenestrating or reconstituting subtype. Results: The cohort included a total of 105 patients who underwent laparoscopic cholecystectomy and 31 patients who underwent laparoscopic subtotal cholecystectomy. Bile leaks (25.8% vs 1.0%, relative risk 3.5, 95% confidence interval 3.5-208.4) were more common in the laparoscopic subtotal cholecystectomy group. Postoperative endoscopic retrograde cholangiopancreatography (22.6% vs 3.8%, relative risk 5.9, 95% confidence interval 1.9-18.9) and biliary stent insertion (19.4% vs 1.0%, relative risk 20.3, 95% confidence interval 2.5-162.5) were also more common in the laparoscopic subtotal cholecystectomy group. Bile leaks in laparoscopic subtotal cholecystectomy were only documented in the fenestration subtype, most of which were successfully managed with endoscopic retrograde cholangiopancreatography and biliary stenting. Compared to our previous study of laparoscopic cholecystectomy and subtotal cholecystectomy for severe cholecystitis between 2010 and 2016, there has been a decrease in postoperative laparoscopic cholecystectomy complications, subtotal cholecystectomy cases, and no bile duct injuries. Conclusion: Following our algorithmic approach to safe laparoscopic cholecystectomy has helped to prevent bile duct injury. Laparoscopic cholecystectomy remains the gold standard for the management of severe cholecystitis; however, in extreme cases, laparoscopic subtotal cholecystectomy is a safe bailout strategy with manageable morbidity. (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20240207 Date Completed: 20240318 Latest Revision: 20240318 |
| رمز التحديث: | 20240318 |
| DOI: | 10.1016/j.surg.2023.12.026 |
| PMID: | 38326217 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1532-7361 |
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| DOI: | 10.1016/j.surg.2023.12.026 |