Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Surg Endosc. 2021 Mar;35(3):1014-1024. doi: 10.1007/s00464-020-08096-0. Epub 2020 Oct 30.
Laparoscopic subtotal cholecystectomy (LSC) is a safe bailout procedure in situations when dissection of "critical view of safety" is not possible. After the proposed classification of subtotal cholecystectomy into "fenestrating" and "reconstituting" techniques in 2016, a comparative review of the outcomes of both methods is timely.
A literature search of the PubMed, Cochrane Library, and Web of Science database was conducted up to January 31, 2020 for studies that reported LSC. Studies reporting LSC only in patients with Mirizzi syndrome or xanthogranulomatous cholecystitis were excluded. Our analysis includes 39 studies with 1784 cases of LSC. We report a comparison of outcomes between reconstituting and fenestrating LSC on 1505 cases [935 reconstituting (62.1%) and 570 fenestrating (37.9%)].
Following LSC, the rate of open conversion is 7.7%, hemorrhage is 0.4%, bile duct injury is 0.3%, bile leak is 15.4%, retained stone is 4.6%, subhepatic or subphrenic collection is 2.9%, superficial surgical site infection is 2.0% and 30-day mortality is 0.2%. 8.8% of patients required postoperative endoscopic retrograde cholangiopancreatography (ERCP), 1.1% required percutaneous intervention, and 2.2% required reoperation. Compared to reconstituting LSC, fenestrating LSC has a higher incidence of open conversion (n = 58, 10.2% vs. n = 43, 4.6%, p < 0.001), retained stones (n = 38, 6.7% vs. n = 38, 4.1%, p = 0.0253), subhepatic or subphrenic collections (n = 33, 5.8% vs. n = 13, 1.4%, p < 0.001), superficial surgical site infections (n = 18, 3.2% vs. n = 14, 1.5%, p = 0.0303), postoperative ERCP (n = 82, 14.4% vs. n = 62, 6.6%, p < 0.001), and need for reoperation (n = 20, 3.5% vs. n = 12, 1.3%, p < 0.001).
Although reconstituting LSC has better outcomes, both techniques are complementary. Intraoperative findings and surgical expertise impact the choice.
腹腔镜胆囊次全切除术（LSC）是在无法进行“安全视野”解剖时的安全抢救手术。2016 年提出胆囊次全切除术的“开窗”和“重建”技术分类后，对两种方法的结果进行比较是及时的。
我们对 PubMed、Cochrane 图书馆和 Web of Science 数据库进行了文献检索，检索时间截至 2020 年 1 月 31 日，以获取报道 LSC 的研究。排除仅在胆石性胰腺炎或黄色肉芽肿性胆囊炎患者中报告 LSC 的研究。我们的分析包括 39 项研究，共 1784 例 LSC。我们报告了 1505 例重建和开窗 LSC 之间的结果比较[935 例重建（62.1%）和 570 例开窗（37.9%）]。
LSC 后，开放转化率为 7.7%，出血率为 0.4%，胆管损伤率为 0.3%，胆漏率为 15.4%，残余结石率为 4.6%，肝下或膈下积液率为 2.9%，浅表手术部位感染率为 2.0%，30 天死亡率为 0.2%。8.8%的患者需要术后内镜逆行胰胆管造影（ERCP），1.1%需要经皮介入，2.2%需要再次手术。与重建 LSC 相比，开窗 LSC 的开放转化率更高（n=58，10.2%vs.n=43，4.6%，p<0.001），残余结石（n=38，6.7%vs.n=38，4.1%，p=0.0253），肝下或膈下积液（n=33，5.8%vs.n=13，1.4%，p<0.001），浅表手术部位感染（n=18，3.2%vs.n=14，1.5%，p=0.0303），术后 ERCP（n=82，14.4%vs.n=62，6.6%，p<0.001），需要再次手术（n=20，3.5%vs.n=12，1.3%，p<0.001）。
尽管重建 LSC 的结果更好，但两种技术都是互补的。术中发现和手术经验会影响选择。
