Our Summary

This research paper is about a study conducted on a specific type of surgery called laparoscopic subtotal cholecystectomy (LSC). This technique is used during difficult gallbladder removals to avoid injuring the bile duct and having to switch to an open surgery. The study analyzed data from previous surgeries to determine how often LSC was used and what the outcomes were.

Out of 624 gallbladder removals, 53 (or about 8.5%) required LSC. The majority of these (81.8%) were a specific type of LSC called a fenestrating LSC. The study found that men and older patients were more likely to need an LSC. Patients who had the surgery on the same day they were admitted to the hospital, those who had previous surgeries, those who had a preoperative ERCP (a type of procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas), or those who had a percutaneous cholecystostomy (a procedure to drain the gallbladder) were also more likely to need an LSC.

The most common reason for needing an LSC was a necrotic gallbladder - one that is dying or decaying. Other factors that made the surgery difficult included a contracted gallbladder, extensive adhesions (scar tissue), an empyema in the gallbladder (a collection of pus), and severe inflammation.

About a quarter of patients who had an LSC experienced complications after the surgery. These included serious complications, the need for ERCPs, and the need for follow-up surgeries. More patients in the LSC group developed bile leaks. However, there were only two readmissions within 30 days, one death, and no bile duct injuries in the LSC group.

In conclusion, the study found that LSC is a viable option for complex gallbladder inflammation.

FAQs

  1. What is Laparoscopic Subtotal Cholecystectomy (LSC) and how is it different from Laparoscopic Cholecystectomy (LC)?
  2. What are the risk factors and predictors for needing a Laparoscopic Subtotal Cholecystectomy (LSC)?
  3. What are the potential postoperative complications of Laparoscopic Subtotal Cholecystectomy (LSC)?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic cholecystectomy is to carefully follow postoperative care instructions to reduce the risk of complications such as bile leaks. This may include avoiding heavy lifting, sticking to a low-fat diet, and staying hydrated. It’s also important to attend follow-up appointments with your surgeon to monitor your recovery and address any concerns promptly.

Suitable For

Patients who are typically recommended for laparoscopic cholecystectomy include those with difficult cholecystectomies, such as those with a history of previous surgery, preoperative ERCP, or percutaneous cholecystostomy. Patients with a necrotic gallbladder, contracted gallbladder, extensive adhesions, gallbladder empyema, and severe inflammation are also candidates for laparoscopic cholecystectomy. Additionally, patients who present with a high risk of bile duct injury may benefit from laparoscopic subtotal cholecystectomy as a safer alternative to open conversion.

Timeline

  • Before laparoscopic cholecystectomy:
  1. Patient presents with symptoms of gallbladder disease, such as abdominal pain, nausea, and vomiting.
  2. Patient undergoes diagnostic tests, such as ultrasound or CT scan, to confirm the presence of gallstones.
  3. Surgeon determines that laparoscopic cholecystectomy is necessary due to the patient’s condition.
  4. Patient may undergo preoperative preparation, such as fasting and stopping certain medications.
  • After laparoscopic cholecystectomy:
  1. Patient undergoes the laparoscopic cholecystectomy procedure, which involves making small incisions in the abdomen and using a camera to remove the gallbladder.
  2. Patient may experience some pain and discomfort in the days following the surgery.
  3. Patient is discharged from the hospital typically within 1-2 days after the surgery.
  4. Patient is instructed on postoperative care, such as diet restrictions and wound care.
  5. Patient may experience some side effects, such as bloating or diarrhea, as the body adjusts to the absence of the gallbladder.
  6. Patient follows up with the surgeon for any complications or concerns, and typically resumes normal activities within a few weeks.

What to Ask Your Doctor

  1. What is laparoscopic subtotal cholecystectomy (LSC) and why might it be necessary for my cholecystectomy?
  2. What are the specific risk factors or conditions that may indicate the need for a LSC instead of a traditional laparoscopic cholecystectomy (LC)?
  3. How does the recovery process and timeline differ between LSC and LC?
  4. What are the potential complications or risks associated with LSC compared to LC?
  5. Are there any long-term implications or considerations I should be aware of if I undergo a LSC?
  6. How experienced are you and your surgical team in performing LSC procedures?
  7. What is your success rate with LSC procedures and how do you monitor and manage any potential complications?
  8. Are there any specific pre-operative or post-operative instructions or precautions I should follow if I undergo a LSC?
  9. How will my pain management and post-operative care plan differ if I undergo a LSC compared to a LC?
  10. Are there any alternative treatment options or approaches that I should consider before proceeding with a LSC?

Reference

Authors: Booyse K, Lindemann J, Calitz M, Bernon M, Jonas E, Kloppers C. Journal: World J Surg. 2024 Jun;48(6):1323-1330. doi: 10.1002/wjs.12180. Epub 2024 Apr 6. PMID: 38581358