Our Summary

This research compared two types of surgeries used to remove inflamed gallbladders - subtotal cholecystectomy (SC) and total cholecystectomy (TC). The gallbladder can be challenging to remove if it is severely inflamed, and there is not much research comparing these two methods in such cases.

The researchers looked at several medical databases and found ten relevant studies. They found that while SC was less likely to result in injury to the common bile duct (CBD), it was more likely to cause complications like bile leaks, the need for post-surgery endoscopy, collections of fluid in the abdomen, and the need for additional surgery.

The conclusion is that SC is a viable alternative to TC for removing difficult gallbladders and may lower the risk of CBD injuries. However, doctors should be aware of both methods to ensure they choose the best approach for each patient and reduce the risk of harm. Further research is needed to evaluate the benefits of SC in difficult gallbladder removals.

FAQs

  1. What are the two types of surgeries used to remove inflamed gallbladders?
  2. What are the potential complications associated with subtotal cholecystectomy (SC)?
  3. Is one method of cholecystectomy (SC or TC) considered safer or more effective based on the research findings?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cholecystectomy is to discuss with them the risks and benefits of both subtotal and total cholecystectomy, especially in cases where the gallbladder is severely inflamed. It is important for patients to be informed about the potential complications and outcomes of each type of surgery so they can make an informed decision with their healthcare provider.

Suitable For

Patients who are typically recommended cholecystectomy include those with gallstones, gallbladder inflammation (cholecystitis), gallbladder polyps, or gallbladder cancer. Additionally, patients with recurrent gallbladder attacks or complications from gallstones, such as pancreatitis or jaundice, may also be recommended for cholecystectomy. In cases where the gallbladder is severely inflamed or difficult to remove, subtotal cholecystectomy may be considered as an alternative to total cholecystectomy.

Timeline

Before cholecystectomy:

  1. Patient experiences symptoms of gallbladder disease such as abdominal pain, nausea, vomiting, and bloating.
  2. Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the presence of gallstones or inflammation in the gallbladder.
  3. Patient may be prescribed medications to manage symptoms and prevent complications.
  4. Patient may be advised to follow a low-fat diet to reduce symptoms.

After cholecystectomy:

  1. Patient undergoes surgery to remove the inflamed gallbladder.
  2. Patient may experience pain, discomfort, and fatigue in the immediate post-operative period.
  3. Patient is advised to rest and follow post-operative care instructions such as wound care, pain management, and diet restrictions.
  4. Patient may return to normal activities gradually as recommended by their healthcare provider.
  5. Patient may experience digestive changes such as diarrhea or bloating due to the absence of the gallbladder.
  6. Patient may need to follow a special diet or take bile acid supplements to aid in digestion.
  7. Patient may have follow-up appointments with their healthcare provider to monitor recovery and address any complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a cholecystectomy procedure?
  2. How will my recovery process differ between subtotal cholecystectomy and total cholecystectomy?
  3. What factors will determine whether subtotal cholecystectomy or total cholecystectomy is the best option for me?
  4. What is the likelihood of needing additional surgery or interventions after a subtotal cholecystectomy compared to a total cholecystectomy?
  5. How experienced are you in performing both subtotal cholecystectomy and total cholecystectomy procedures?
  6. What measures will be taken to prevent common bile duct injuries during the cholecystectomy procedure?
  7. What is the success rate of each type of surgery in removing difficult or severely inflamed gallbladders?
  8. How long can I expect to be in the hospital and what is the typical recovery time for each type of cholecystectomy?
  9. Will I need to make any lifestyle changes or follow a specific diet after the cholecystectomy procedure?
  10. Are there any long-term implications or risks associated with choosing subtotal cholecystectomy over total cholecystectomy?

Reference

Authors: Koo SS, Krishnan RJ, Ishikawa K, Matsunaga M, Ahn HJ, Murayama KM, Kitamura RK. Journal: Am J Surg. 2024 Mar;229:145-150. doi: 10.1016/j.amjsurg.2023.12.022. Epub 2023 Dec 20. PMID: 38168604