Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
Am Surg. 2024 Jun;90(6):1800-1802. doi: 10.1177/00031348241241617. Epub 2024 Apr 2.
Laparoscopic subtotal cholecystectomy (LSC) is utilized to prevent complications in the difficult cholecystectomy. Medium-term outcomes are poorly studied for fenestrating and reconstituting operative techniques. A single-institution retrospective review was undertaken of all LSCs. A telephone survey was used to identify complications addressed at other institutions. We performed subgroup analyses by operative approach and of patients requiring postoperative endoscopic intervention (ERC). 28 patients met inclusion criteria. The median follow-up was 32.7 months. There were no bile duct injuries or reoperations. 21% of patients required a postoperative ERC and 50% were discharged home with a drain. Bile leaks were found to be more prevalent in the fenestrating LSC group (38% vs 0%, = .003). The case series suggested more severe recurrent biliary disease in patients undergoing reconstituting LSC. Laparoscopic subtotal cholecystectomy appears to have satisfactory medium-term outcomes. The reconstituting LSC group trends toward more severe recurrent disease which warrants further investigation.
腹腔镜胆囊次全切除术（LSC）用于预防困难性胆囊切除术的并发症。对于开窗和重建手术技术，中期结果研究甚少。对所有 LSC 进行了单机构回顾性研究。使用电话调查确定了在其他机构处理的并发症。我们根据手术方法和需要术后内镜干预（ERC）的患者进行了亚组分析。符合纳入标准的 28 例患者。中位随访时间为 32.7 个月。没有胆管损伤或再次手术。21%的患者需要术后 ERC，50%的患者带引流管出院回家。发现开窗 LSC 组的胆漏更为常见（38%比 0%，.003）。病例系列表明，行重建 LSC 的患者复发性胆道疾病更为严重。腹腔镜胆囊次全切除术具有令人满意的中期结果。重建的 LSC 组倾向于更严重的复发性疾病，这需要进一步研究。
