Our Summary

This research paper is about a surgical procedure known as subtotal cholecystectomy (STC), which is a less intensive alternative to total cholecystectomy (TC) - the removal of the gallbladder. STC is often used in cases where severe inflammation or other complications make a full removal of the gallbladder risky.

The study looked at patients who had the STC procedure at their medical unit from February 2009 to August 2019. They divided the STC into two types: one where the remaining part of the gallbladder was closed (R-STC) and one where it was left open (F-STC).

Out of 5,664 patients who had some form of gallbladder removal during the study period, 97 (or about 1.7%) had STC. Almost half of these cases had to be converted from a less invasive laparoscopic procedure to a more traditional open surgery, and a significant number (45.4%) had post-surgery complications. Interestingly, they found no cases of accidental bile duct injury, which can be a risk in these types of surgeries.

However, about 20% of patients had a bile leak after surgery. This was more common in patients who had the surgery in response to an acute condition rather than as a planned procedure. There was no difference in complications between the two types of STC.

In conclusion, the researchers found that while STC can be an effective way to avoid bile duct injury in complex gallbladder removal cases, it does come with a relatively high risk of complications. They suggest that surgeons should be aware of these risks and take steps to minimize them.

FAQs

  1. What is the purpose of a subtotal cholecystectomy (STC)?
  2. What is the difference between reconstituting (R-STC) and fenestrating (F-STC) types of STC?
  3. What are the potential risks and complications associated with subtotal cholecystectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cholecystectomy is to discuss the potential risks and benefits of subtotal cholecystectomy (STC) versus total cholecystectomy (TC). While STC can help avoid bile duct injury in difficult cases, it is important to be aware of the higher perioperative morbidity associated with STC and take appropriate steps to minimize risks. Patients should have a thorough discussion with their surgeon to make an informed decision about the best approach for their individual situation.

Suitable For

Patients who are typically recommended for cholecystectomy include those with symptomatic gallstones, acute cholecystitis, chronic cholecystitis, gallbladder polyps, gallbladder cancer, biliary dyskinesia, and choledocholithiasis. Additionally, patients with severe inflammation or adhesions around the hepatocystic triangle may be considered for subtotal cholecystectomy as an alternative to total cholecystectomy.

Timeline

  • Before cholecystectomy: The patient may experience symptoms such as abdominal pain, nausea, vomiting, and bloating due to gallstones or inflammation of the gallbladder. Diagnostic tests such as ultrasound or CT scan may be performed to confirm the need for surgery.
  • Day of cholecystectomy: The patient undergoes the surgical procedure, which can be done laparoscopically or through open surgery, to remove the gallbladder. In some cases, if severe inflammation or adhesions are present, a subtotal cholecystectomy may be performed.
  • After cholecystectomy: The patient may experience some pain and discomfort in the abdomen, which can be managed with pain medication. They are typically discharged from the hospital within a few days and advised on post-operative care, including dietary restrictions and activity levels.
  • Follow-up appointments: The patient may have follow-up appointments with their surgeon to monitor their recovery and address any concerns or complications. In some cases, further imaging or tests may be required to ensure proper healing.

What to Ask Your Doctor

  1. What are the reasons for considering a subtotal cholecystectomy instead of a total cholecystectomy in my case?
  2. What type of subtotal cholecystectomy (reconstituting or fenestrating) would be most appropriate for me?
  3. What are the potential risks and complications associated with a subtotal cholecystectomy?
  4. How experienced are you in performing subtotal cholecystectomies?
  5. What is the likelihood of needing a conversion to open surgery during the procedure?
  6. How long is the recovery period expected to be after a subtotal cholecystectomy?
  7. Will I need any special follow-up care or monitoring after the procedure?
  8. How will a subtotal cholecystectomy affect my digestion and overall health in the long term?
  9. Are there any alternative treatments or procedures that could be considered instead of a subtotal cholecystectomy?
  10. What is the success rate of subtotal cholecystectomy in cases like mine?

Reference

Authors: Ibrahim R, Abdalkoddus M, Mahendran B, Mownah OA, Nawara H, Aroori S. Journal: Ann R Coll Surg Engl. 2023 May;105(5):455-460. doi: 10.1308/rcsann.2021.0291. Epub 2021 Nov 25. PMID: 34821508