Department of Surgery, Nakagami Hospital, Noborikawa 610, Okinawa, 904-2195, Japan.
Langenbecks Arch Surg. 2024 Aug 15;409(1):251. doi: 10.1007/s00423-024-03438-1.
A critical view of safety (CVS) is important to ensure safe laparoscopic cholecystectomy. When the CVS is not possible, subtotal cholecystectomy is performed. While considering subtotal cholecystectomy, surgeons are often concerned about preventing bile leakage from the cystic ducts. The two main types of subtotal cholecystectomy for acute cholecystitis are fenestrating and reconstituting. Previously, there were no selection criteria for these two; therefore, open conversion was performed. This study aimed to evaluate our goal-oriented approach to choose fenestrating or reconstituting subtotal cholecystectomy for acute cholecystitis.
We introduced our goal-oriented approach in April 2019. Before introducing this approach, laparoscopic cholecystectomy for acute cholecystitis was performed without criteria for subtotal cholecystectomy. After our approach was introduced, laparoscopic cholecystectomy for acute cholecystitis was performed according to the subtotal cholecystectomy criteria. We retrospectively reviewed the medical records of patients who underwent laparoscopic cholecystectomy for acute cholecystitis between 2015 and 2021. Laparoscopic cholecystectomy for acute cholecystitis was performed by surgeons regardless of whether they were novices or veterans.
The period from April 2015 to March 2019 was before the introduction (BI) of our approach, the period from April 2019 to December 2021 was after the introduction (AI) of our approach. There were 177 and 186 patients with acute cholecystitis during the BI and AI periods, respectively. There were no significant differences between groups in terms of preoperative characteristics, operative time, and blood loss. No difference in the laparoscopic subtotal cholecystectomy rate between groups (10.2% [BI] vs. 13.9% [AI]; p = 0.266) was obserbed. The open conversion rate during the BI period was significantly higher than that during the AI period (7.4% vs. 1.6%; p = 0.015).
Our goal-oriented approach is feasible, safe, and easy for many surgeons to understand.
安全关键视图（CVS）对于确保腹腔镜胆囊切除术的安全至关重要。当 CVS 不可能时，进行次全胆囊切除术。在考虑次全胆囊切除术时，外科医生通常担心防止胆囊管胆汁漏出。急性胆囊炎的两种主要次全胆囊切除术类型是开窗和重建。以前，这两种方法都没有选择标准，因此进行了开放转换。本研究旨在评估我们有针对性的方法来选择开窗或重建急性胆囊炎的次全胆囊切除术。
我们在 2019 年 4 月引入了我们的有针对性的方法。在引入该方法之前，急性胆囊炎的腹腔镜胆囊切除术没有次全胆囊切除术的标准。引入该方法后，根据次全胆囊切除术标准进行急性胆囊炎的腹腔镜胆囊切除术。我们回顾性分析了 2015 年至 2021 年间接受腹腔镜胆囊切除术治疗的急性胆囊炎患者的病历。腹腔镜胆囊切除术由外科医生进行，无论他们是新手还是经验丰富的医生。
2015 年 4 月至 2019 年 3 月为引入方法前（BI）期，2019 年 4 月至 2021 年 12 月为引入方法后（AI）期。BI 期和 AI 期各有 177 例和 186 例急性胆囊炎患者。两组患者术前特征、手术时间和出血量均无显著差异。两组腹腔镜次全胆囊切除术率无差异（10.2%[BI]与 13.9%[AI]；p=0.266）。BI 期开放转化率明显高于 AI 期（7.4%比 1.6%；p=0.015）。
我们的有针对性的方法是可行的，安全的，并且易于许多外科医生理解。
