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Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy
BACKGROUND: Laparoscopic Cholecystectomy one of the commonest procedures performed worldwide isn't spared from the risks of disastrous iatrogenic complications. In patients with obscured anatomy, the idea of performing a safe total cholecystectomy can be hindered with a high risk of biliovascul...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597868/ https://www.ncbi.nlm.nih.gov/pubmed/32978351 http://dx.doi.org/10.4103/jmas.JMAS_2_19 |
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author | Bairoliya, Kushal Rajan, Ramesh Sindhu, R. S. Natesh, Bonny Mathew, Jacob Raviram, S. |
author_facet | Bairoliya, Kushal Rajan, Ramesh Sindhu, R. S. Natesh, Bonny Mathew, Jacob Raviram, S. |
author_sort | Bairoliya, Kushal |
collection | PubMed |
description | BACKGROUND: Laparoscopic Cholecystectomy one of the commonest procedures performed worldwide isn't spared from the risks of disastrous iatrogenic complications. In patients with obscured anatomy, the idea of performing a safe total cholecystectomy can be hindered with a high risk of biliovascular injuries. In such a situation STC (subtotal cholecystectomy) comes to the rescue, where the diseased organ can be tackled fairly, without any further damage. AIMS AND OBJECTIVES: The primary aim was to look at the immediate and long-term outcomes of subtotal cholecystectomy. Subgroup analysis was done based on demographics, indications and surgical approach. MATERIALS AND METHODS: We reviewed our prospectively maintained computerized operation database over nine years. STC was defined as leaving behind any portion of gallbladder other than the cystic duct. They were subclassified as per the description given by Palanivelu. Patients were evaluated with laboratory and radiological assessment. RESULTS: A total of 70 out of 602 patients (11.6%) underwent STC. Dense adhesion at the calot's was the most important reason for STC. Subtype B was the most common. Nine patients (12.85%) had a bile leak in the postoperative period. There were no biliary/vascular injuries and 30-day mortality was zero. 22.8% developed SSI (surgical site infection). Over a median follow up of 38 months (range 5-98), clinical examination, LFT and USG revealed no abnormality in any of the patients. CONCLUSION: Subtotal cholecystectomy is a useful alternative during difficult gallbladder surgery. It should be considered early into the procedure preferably prior to conversion to an open procedure. Biliovascular injuries can be avoided and the Immediate and long-term outcomes are acceptable. |
format | Online Article Text |
id | pubmed-7597868 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-75978682020-11-03 Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy Bairoliya, Kushal Rajan, Ramesh Sindhu, R. S. Natesh, Bonny Mathew, Jacob Raviram, S. J Minim Access Surg Original Article BACKGROUND: Laparoscopic Cholecystectomy one of the commonest procedures performed worldwide isn't spared from the risks of disastrous iatrogenic complications. In patients with obscured anatomy, the idea of performing a safe total cholecystectomy can be hindered with a high risk of biliovascular injuries. In such a situation STC (subtotal cholecystectomy) comes to the rescue, where the diseased organ can be tackled fairly, without any further damage. AIMS AND OBJECTIVES: The primary aim was to look at the immediate and long-term outcomes of subtotal cholecystectomy. Subgroup analysis was done based on demographics, indications and surgical approach. MATERIALS AND METHODS: We reviewed our prospectively maintained computerized operation database over nine years. STC was defined as leaving behind any portion of gallbladder other than the cystic duct. They were subclassified as per the description given by Palanivelu. Patients were evaluated with laboratory and radiological assessment. RESULTS: A total of 70 out of 602 patients (11.6%) underwent STC. Dense adhesion at the calot's was the most important reason for STC. Subtype B was the most common. Nine patients (12.85%) had a bile leak in the postoperative period. There were no biliary/vascular injuries and 30-day mortality was zero. 22.8% developed SSI (surgical site infection). Over a median follow up of 38 months (range 5-98), clinical examination, LFT and USG revealed no abnormality in any of the patients. CONCLUSION: Subtotal cholecystectomy is a useful alternative during difficult gallbladder surgery. It should be considered early into the procedure preferably prior to conversion to an open procedure. Biliovascular injuries can be avoided and the Immediate and long-term outcomes are acceptable. Wolters Kluwer - Medknow 2020 2020-09-17 /pmc/articles/PMC7597868/ /pubmed/32978351 http://dx.doi.org/10.4103/jmas.JMAS_2_19 Text en Copyright: © 2020 Journal of Minimal Access Surgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Bairoliya, Kushal Rajan, Ramesh Sindhu, R. S. Natesh, Bonny Mathew, Jacob Raviram, S. Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title | Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title_full | Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title_fullStr | Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title_full_unstemmed | Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title_short | Is a difficult gallbladder worth removing in its entirety? – Outcomes of subtotal cholecystectomy |
title_sort | is a difficult gallbladder worth removing in its entirety? – outcomes of subtotal cholecystectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597868/ https://www.ncbi.nlm.nih.gov/pubmed/32978351 http://dx.doi.org/10.4103/jmas.JMAS_2_19 |
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