Jennifer A Rich, BS, Guillaume S Chevrollier, MD, Andrew Brown, MD, Emanual Okolo, BS, Adam Berger, MD, Ernest L Rosato, MD, Francesco Palazzo, MD, Michael J Pucci, MD. Sidney Kimmel Medical College of Thomas Jefferson University
INTRODUCTION: Subtotal cholecystectomy (SC) is a standard operation utilized to prevent bile duct injury (BDI) when the Critical View of Safety cannot be safely achieved when encountering the difficult gallbladder. Although SC remains safe, the long-term implications, such as quality of life and need for further intervention, are less well known.
METHODS AND PROCEDURES: All patients who underwent cholecystectomy at our institution since 2011 were identified in a retrospectively collected, IRB-approved database. Operative notes where carefully reviewed to identify all cases of SC, along with the appropriate subtype grouping (fenestrating or reconstituting). SC patients where matched to contemporary cases of total cholecystectomy (TC) based upon age, sex, and procedure method (open or laparoscopic). Patient charts were carefully reviewed for perioperative and long-term outcomes, including re-interventions and additional surgical procedures. The patients were subsequently contacted via telephone and asked to complete SF-36 and GIQOL surveys.
RESULTS: Sixty-three cases (2.6%) of SC where identified out of 2418 cases (15 fenestrating, 48 reconstituting). Thirty (48%) cases were completed laparoscopically. Demographics of the two matched cohorts are presented in Table 1. Five SC patients required re-operative completion cholecystectomy for recurrent biliary disease. No TC patients required reoperation, however 2 major BDI occurred in this group (3%), versus no major BDI in the SC group. Quality of life surveys were completed in 21 (33%) SC and 23 (37%) TC patients. SF-36 and GIQOL scores are non-significant between groups with the exception of one sub-category “role limitations due to physical health,” which was improved in the SC group.
Table 1. Patient demographic data
CONCLUSIONS: In our series, long-term QOL scores do not differ between patients undergoing SC and TC. SC may be protective of major BDI; however it clearly comes with an increased risk for the need for re-operative procedures. SC should be considered in difficult operative scenarios, however, patients should be followed for recurrent biliary disease and need for re-operative management.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88347
Program Number: P121
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster