Our Summary

This research paper is a study on two methods of performing a certain type of gallbladder surgery called laparoscopic subtotal cholecystectomy. This procedure is a backup plan when the preferred method isn’t possible. The two techniques are called “reconstituting” and “fenestrating”. The researchers looked at previous studies and records of these surgeries up until January 2020, which included 1784 cases.

The study found that after this type of surgery, about 7.7% of patients needed to switch to open surgery, 0.4% experienced bleeding, 0.3% had bile duct injury, 15.4% had bile leak, 4.6% had retained stones, 2.9% had fluid collection under the liver or diaphragm, 2.0% had superficial surgical site infection, and 0.2% died within 30 days of the surgery. About 8.8% of patients needed a special procedure to examine the bile or pancreatic ducts after surgery, 1.1% required a percutaneous intervention (a procedure to remove fluid or to place a drain), and 2.2% needed another operation.

When comparing the two techniques, the fenestrating method had higher rates of needing open surgery, retained stones, fluid collection under the liver or diaphragm, superficial surgical site infections, a special procedure to examine the bile or pancreatic ducts, and need for another operation.

In conclusion, while the reconstituting technique had better results, both methods can be used depending on the situation during surgery and the surgeon’s expertise.

FAQs

  1. What is a laparoscopic subtotal cholecystectomy and what are the two techniques for performing it?
  2. What were the findings of the study about the complications that may arise from a laparoscopic subtotal cholecystectomy?
  3. How did the two methods, reconstituting and fenestrating, compare in terms of post-operative complications and need for additional operations?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic cholecystectomy is to follow all pre-operative instructions carefully, including fasting before the surgery and avoiding certain medications. Additionally, it is important to communicate any concerns or questions with your surgeon before the procedure to ensure a successful outcome. After surgery, follow post-operative care instructions closely to promote a smooth recovery and minimize the risk of complications.

Suitable For

Typically, patients who are recommended for laparoscopic cholecystectomy are those who have symptomatic gallstones causing pain, inflammation, or infection in the gallbladder. It is also recommended for patients who have complications such as gallbladder polyps, gallbladder sludge, or small gallbladder stones. Additionally, patients who are at a higher risk for complications from traditional open surgery, such as obese patients or those with multiple comorbidities, may also be recommended for laparoscopic cholecystectomy. Overall, laparoscopic cholecystectomy is a commonly performed and safe procedure for patients with gallbladder issues.

Timeline

Before the laparoscopic cholecystectomy:

  1. Patient experiences symptoms of gallbladder issues such as pain in the upper right abdomen, nausea, vomiting, and bloating.
  2. Patient undergoes diagnostic tests such as ultrasound or CT scan to confirm the presence of gallstones.
  3. Patient consults with a surgeon to discuss the need for surgery and the risks and benefits of laparoscopic cholecystectomy.

After the laparoscopic cholecystectomy:

  1. Patient is monitored in the recovery room immediately after surgery for any complications.
  2. Patient may experience some pain and discomfort at the incision sites, which can be managed with pain medication.
  3. Patient is discharged from the hospital within a day or two after surgery.
  4. Patient is advised to rest and avoid strenuous activities for a few days to allow for proper healing.
  5. Patient may experience some changes in diet and digestive patterns as the body adjusts to the absence of the gallbladder.
  6. Patient follows up with the surgeon for post-operative care and monitoring of any potential complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic cholecystectomy include:

  1. What is laparoscopic subtotal cholecystectomy and when is it necessary?
  2. What are the potential complications or risks associated with this surgery?
  3. What is the difference between the “reconstituting” and “fenestrating” techniques for this procedure?
  4. How will the decision be made on which technique to use during my surgery?
  5. What is your experience with performing laparoscopic subtotal cholecystectomy?
  6. What is the expected recovery time and post-operative care for this procedure?
  7. What symptoms should I watch out for after surgery that may indicate a complication?
  8. Will I need any follow-up procedures or tests after the surgery?
  9. What lifestyle changes or dietary modifications should I make after the surgery?
  10. Are there any long-term effects or considerations I should be aware of following this surgery?

Reference

Authors: Koo JGA, Chan YH, Shelat VG. Journal: Surg Endosc. 2021 Mar;35(3):1014-1024. doi: 10.1007/s00464-020-08096-0. Epub 2020 Oct 30. PMID: 33128079