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Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity.

Publication ,  Journal Article
Lidsky, ME; Speicher, PJ; Ezekian, B; Holt, EW; Nussbaum, DP; Castleberry, AW; Perez, A; Pappas, TN
Published in: HPB (Oxford)
June 2017

BACKGROUND: Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. METHODS: Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct. After propensity matching, we investigated surgical indications, perioperative outcomes, and the necessity for secondary ERCP, percutaneous drainage, and completion cholecystectomy. RESULTS: 65 (0.39%) patients underwent subtotal cholecystectomy; 54 (83.1%) began laparoscopically, of which 30 (55.6%) required conversion to laparotomy. Subtotal cholecystectomy, performed more frequently for acute cholecystitis (70.8% vs 34.6%), was associated with extended hospitalizations (4 d vs 2 d) and frequent surgical site infections (20% vs 4.6%). 25 (38.5%) subtotal cholecystectomy patients required ≥1 secondary intervention, and compared to standard cholecystectomy, underwent higher rates postoperative ERCP (30.8% vs 5.4%), percutaneous drainage (9.2% vs 1.5%), and completion cholecystectomy (6.2% vs 0%) [all P < 0.05]. DISCUSSION: Subtotal cholecystectomy fails to control the cystic duct, resulting in significant morbidity. Most do not require completion cholecystectomy; however, patients demand close observation and, frequently, secondary interventions.

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Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

June 2017

Volume

19

Issue

6

Start / End Page

547 / 556

Location

England

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Gallbladder Diseases
  • Female
 

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Lidsky, M. E., Speicher, P. J., Ezekian, B., Holt, E. W., Nussbaum, D. P., Castleberry, A. W., … Pappas, T. N. (2017). Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity. HPB (Oxford), 19(6), 547–556. https://doi.org/10.1016/j.hpb.2017.02.441
Lidsky, Michael E., Paul J. Speicher, Brian Ezekian, Edwin W. Holt, Daniel P. Nussbaum, Anthony W. Castleberry, Alexander Perez, and Theodore N. Pappas. “Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity.HPB (Oxford) 19, no. 6 (June 2017): 547–56. https://doi.org/10.1016/j.hpb.2017.02.441.
Lidsky ME, Speicher PJ, Ezekian B, Holt EW, Nussbaum DP, Castleberry AW, et al. Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity. HPB (Oxford). 2017 Jun;19(6):547–56.
Lidsky, Michael E., et al. “Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity.HPB (Oxford), vol. 19, no. 6, June 2017, pp. 547–56. Pubmed, doi:10.1016/j.hpb.2017.02.441.
Lidsky ME, Speicher PJ, Ezekian B, Holt EW, Nussbaum DP, Castleberry AW, Perez A, Pappas TN. Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity. HPB (Oxford). 2017 Jun;19(6):547–556.
Journal cover image

Published In

HPB (Oxford)

DOI

EISSN

1477-2574

Publication Date

June 2017

Volume

19

Issue

6

Start / End Page

547 / 556

Location

England

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Postoperative Complications
  • Middle Aged
  • Male
  • Humans
  • Gallbladder Diseases
  • Female