Our Summary

This research paper is about a surgical procedure called laparoscopic subtotal cholecystectomy (LSTC). This is a procedure that’s used when it’s not safe to perform a full gallbladder removal due to complications like dense adhesions in a specific area (Calot’s triangle).

The researchers reviewed 45 studies, involving over 2,000 patients who had this procedure, to understand the early and late risks and complications. They found that the most common reason for having this procedure was due to acute cholecystitis (an inflammation of the gallbladder). In most cases, the gallbladder was closed off, with the most common method being suturing from within the body.

In the month after surgery, few patients died or had a bile duct injury. However, about 18% experienced a bile leak and 4% had an accumulation of fluid in the abdomen. About 1.2% had to have another operation, typically due to uncontrolled bile leaks or unresolved fluid collections in the abdomen.

In the long-term, some patients experienced hernias at the incision site, symptoms from gallstones, or stones in the common bile duct, and about 2% needed to have the rest of the gallbladder removed.

The researchers concluded that LSTC is a good alternative for patients with a complicated Calot’s triangle.

FAQs

  1. What is laparoscopic subtotal cholecystectomy (LSTC) and why is it performed?
  2. What are the early and late risks and complications of the LSTC procedure as found in the research?
  3. What percentage of patients needed another operation after LSTC and what were the common reasons for this?

Doctor’s Tip

Tip: After a cholecystectomy, it’s important to follow your doctor’s recommendations for diet and activity to prevent complications and promote healing. Be sure to report any unusual symptoms or concerns to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for cholecystectomy include those with:

  1. Acute cholecystitis: This is the most common reason for cholecystectomy, as inflammation of the gallbladder can lead to severe pain and complications if left untreated.

  2. Gallstones: Patients with gallstones that cause symptoms such as pain, nausea, and vomiting may be recommended for cholecystectomy to prevent further complications.

  3. Biliary dyskinesia: This condition occurs when the gallbladder does not empty properly, leading to symptoms such as abdominal pain and bloating. Cholecystectomy may be recommended to alleviate these symptoms.

  4. Choledocholithiasis: This is when gallstones are lodged in the common bile duct, leading to symptoms such as jaundice and pancreatitis. Cholecystectomy may be recommended to remove the source of the stones.

  5. Complications from previous cholecystectomy: Patients who have had a previous cholecystectomy and develop complications such as bile duct injury or bile leaks may be recommended for further surgery, such as LSTC.

Overall, patients who are recommended for cholecystectomy are those who are experiencing symptoms or complications related to gallbladder disease that cannot be managed with conservative treatments.

Timeline

Timeline of patient experience:

Before cholecystectomy:

  • Patient experiences symptoms of gallbladder disease, such as abdominal pain, nausea, vomiting, and bloating.
  • Patient undergoes diagnostic tests, such as ultrasound or CT scan, to confirm the presence of gallstones or inflammation.
  • Surgeon recommends cholecystectomy as the treatment option.
  • Patient undergoes pre-operative tests and evaluations to ensure they are fit for surgery.

After cholecystectomy:

  • Patient undergoes laparoscopic subtotal cholecystectomy procedure.
  • In the immediate post-operative period, patient may experience pain and discomfort at the incision sites.
  • Patient is discharged from the hospital within a few days and instructed on post-operative care, including pain management and wound care.
  • In the first month after surgery, patient may experience complications such as bile leaks or fluid accumulation in the abdomen.
  • Long-term follow-up may include monitoring for hernias, gallstone symptoms, or stones in the common bile duct.
  • Some patients may require additional procedures, such as complete gallbladder removal, in the long-term.

Overall, the timeline of patient experience before and after cholecystectomy involves diagnostic tests, surgical intervention, post-operative care, and long-term follow-up to monitor for complications and ensure optimal outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cholecystectomy, specifically laparoscopic subtotal cholecystectomy (LSTC), may include:

  1. What are the reasons for considering a laparoscopic subtotal cholecystectomy instead of a full gallbladder removal?
  2. What are the potential risks and complications associated with LSTC?
  3. How long is the recovery time after LSTC surgery?
  4. Will I need any follow-up procedures or treatments after LSTC?
  5. How likely is it that I will need to have the rest of my gallbladder removed in the future?
  6. What symptoms should I watch out for after LSTC that may indicate a complication?
  7. Are there any dietary or lifestyle changes I should make after LSTC?
  8. How often will I need to follow up with my doctor after LSTC surgery?
  9. What is the success rate of LSTC in relieving symptoms and complications related to the gallbladder?
  10. Are there any alternative treatments or procedures that I should consider before deciding on LSTC?

Reference

Authors: Al-Azzawi M, Abouelazayem M, Parmar C, Singhal R, Amr B, Martinino A, Atıcı SD, Mahawar K. Journal: Ann R Coll Surg Engl. 2024 Mar;106(3):205-212. doi: 10.1308/rcsann.2023.0008. Epub 2023 Jun 27. PMID: 37365939