Zhu Alice, Benedek Leo, Deng Shirley, Tsang Melanie, Bubis Lev, Habbel Christopher, Greene Brittany, Jayaraman Shiva
Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
McGill University, Montreal, Québec, Canada.
Surgery. 2025 Feb;178:108871. doi: 10.1016/j.surg.2024.09.028. Epub 2024 Oct 20.
Laparoscopic subtotal cholecystectomy is an acceptable method of preventing bile duct injuries in "difficult" gallbladders. However, it is associated with postoperative bile leaks and retained gallstones that may necessitate resection of the gallbladder remnant. This study evaluates the outcomes of patients who underwent completion cholecystectomy for ongoing symptoms or complication after subtotal cholecystectomy.
We performed a retrospective review of adults who underwent laparoscopic completion cholecystectomy after previous subtotal cholecystectomy at a single institution from 2009 to 2023. Indications for reoperation were collected and intraoperative findings, operative outcomes, and rates of postoperative morbidity were evaluated.
Over 14 years, 46 patients underwent completion cholecystectomy, with 40 (80%) in the last 5 years. Remnant cholecystitis was the most common reason for reoperation in 37 patients (80.4%). Choledocholithiasis was seen in 4 cases (8.7%). Bile leak, gallstone pancreatitis, and abdominal abscess were observed in 8 (17.4%), 4 (8.7%), and 5 (10.8%) patients, respectively. Four patients (8.7%) had intestinal fistulas intraoperatively. Laparoscopic completion cholecystectomy was attempted in all, with 2 (4.4%) converted to open laparotomy. The median operative time was 111 minutes (interquartile range, 83-140 minutes), and the median hospital stay was 1 day (interquartile range, 0-2 days). Minor complications occurred in 5 patients (10.9%), which were managed conservatively. Four patients had major complications requiring endoscopic retrograde cholangiopancreatography or percutaneous intervention. There were no bile duct injuries or reoperations, and 44 (95.6%) patients had complete symptom resolution at follow-up.
Laparoscopic completion cholecystectomy is feasible and safe but technically challenging. With the increased use of subtotal cholecystectomy, patients presenting with persistent postoperative pain require timely work-up and management of their symptoms.
腹腔镜次全胆囊切除术是预防“困难”胆囊胆管损伤的一种可接受的方法。然而，它与术后胆漏和残留结石有关，这可能需要切除胆囊残余部分。本研究评估了因次全胆囊切除术后持续症状或并发症而接受胆囊全切术患者的结局。
我们对2009年至2023年在单一机构接受过次全胆囊切除术后又接受腹腔镜胆囊全切术的成年人进行了回顾性研究。收集再次手术的指征，并评估术中发现、手术结局和术后发病率。
在14年期间，46例患者接受了胆囊全切术，其中40例（80%）在过去5年。残留胆囊炎是37例患者（80.4%）再次手术的最常见原因。4例（8.7%）发现胆总管结石。分别有8例（17.4%）、4例（8.7%）和5例（10.8%）患者出现胆漏、胆石性胰腺炎和腹腔脓肿。4例患者（8.7%）术中出现肠瘘。所有患者均尝试进行腹腔镜胆囊全切术，其中2例（4.4%）转为开腹手术。中位手术时间为111分钟（四分位间距，83 - 140分钟），中位住院时间为1天（四分位间距，0 - 2天）。5例患者（10.9%）出现轻微并发症，经保守治疗。4例患者出现严重并发症，需要进行内镜逆行胰胆管造影或经皮介入治疗。无胆管损伤或再次手术，44例（95.6%）患者在随访时症状完全缓解。
腹腔镜胆囊全切术可行且安全，但技术上具有挑战性。随着次全胆囊切除术的使用增加，出现持续性术后疼痛的患者需要及时检查并处理其症状。
