Our Summary

This study examined surgeries (cholecystectomies) to remove the gallbladder, which can sometimes be difficult due to inflammation. If the surgery gets too risky, doctors may decide to remove only part of the gallbladder (subtotal cholecystectomy) instead of the whole thing (total cholecystectomy) to avoid causing damage to nearby body parts. This can be done either with a minimally invasive technique (laparoscopic) or a traditional open surgery.

The researchers looked at the records of these surgeries performed at a single academic center from 2015 to 2020. They found that out of a total of 1892 surgeries, 147 of them had to switch to the “bailout” procedure of removing only part of the gallbladder. Most of these patients had high blood pressure or diabetes, and the most common reasons for the switch were difficult anatomy or dense scar tissue.

The average surgery time was about 146 minutes. There were two cases of injury to nearby bile ducts, and about 24% of patients had leakage of bile after surgery. However, there was no difference in the length of hospital stay, infection rate, or death rate between the different types of procedures.

The researchers concluded that removing only part of the gallbladder can be a safe alternative when the surgery becomes too challenging. The decision to use a laparoscopic or open method depends on the surgeon’s skill and experience.

FAQs

  1. What is the difference between a subtotal and total cholecystectomy?
  2. What are the most common reasons to switch to a subtotal cholecystectomy during surgery?
  3. Are there any differences in complications or recovery time between a subtotal and total cholecystectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cholecystectomy is to follow post-operative instructions carefully, including taking prescribed pain medication, avoiding heavy lifting or strenuous activity, and eating a low-fat diet to prevent digestive issues. It is also important to attend follow-up appointments to monitor healing and address any concerns.

Suitable For

Patients who are typically recommended cholecystectomy include those with symptomatic gallstones, gallbladder inflammation (cholecystitis), gallbladder polyps, biliary dyskinesia, or gallbladder cancer. Additionally, patients with recurrent episodes of biliary colic, pancreatitis, or jaundice may also be candidates for cholecystectomy. Ultimately, the decision to recommend cholecystectomy is made on a case-by-case basis by a healthcare provider after evaluating the patient’s medical history, symptoms, and overall health.

Timeline

Before cholecystectomy:

  1. Patient experiences symptoms of gallbladder issues such as abdominal pain, nausea, vomiting, and bloating.
  2. Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm gallbladder disease.
  3. Patient consults with a surgeon to discuss options for cholecystectomy and the risks involved.

During cholecystectomy:

  1. Surgery is performed either laparoscopically or through open surgery.
  2. If surgery becomes too risky, the surgeon may switch to removing only part of the gallbladder (subtotal cholecystectomy).
  3. Surgery time averages about 146 minutes, with potential risks of bile duct injury and bile leakage.

After cholecystectomy:

  1. Patient may experience pain and discomfort at the incision site.
  2. Patient may need to stay in the hospital for a few days for monitoring.
  3. Patient may need to follow a special diet to allow the body to adjust to the absence of the gallbladder.
  4. Patient may experience side effects such as diarrhea or digestive issues in the short term.
  5. Overall, most patients recover well from cholecystectomy and are able to resume normal activities.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a cholecystectomy?
  2. How will my recovery process differ if I have a subtotal cholecystectomy vs. a total cholecystectomy?
  3. What factors would lead you to switch to a subtotal cholecystectomy during the surgery?
  4. How experienced are you in performing both laparoscopic and open cholecystectomies?
  5. What is your plan for managing any potential complications that may arise during or after the surgery?
  6. How long can I expect to be in the hospital after the surgery?
  7. Will I need any additional procedures or treatments following the surgery?
  8. How soon can I expect to return to normal activities after the surgery?
  9. Are there any dietary or lifestyle changes I should make after the surgery?
  10. What follow-up care will be necessary after the surgery?

Reference

Authors: Ledezma Dominguez J, Tariq N, Martins RS, Jawad G, Fisher AD, Maqbool B. Journal: Am Surg. 2024 Jun;90(6):1324-1329. doi: 10.1177/00031348241227186. Epub 2024 Jan 23. PMID: 38259239