Division of General Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia.
Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia.
Medicina (Kaunas). 2024 Oct 8;60(10):1642. doi: 10.3390/medicina60101642.
A difficult gallbladder anatomy augments the risk of bile duct injuries (BDIs) and other complications during a laparoscopic cholecystectomy. This study compares the outcomes of a laparoscopic subtotal cholecystectomy (LSTC) and open total cholecystectomy (OTC) for difficult cholecystectomies. This retrospective analysis of gallbladder procedures (LSTC or OTC) from 2016 to 2023 examined patient demographics, surgical details, and postoperative results. The primary outcome was the incidence of a BDI. Secondary outcomes included operative duration, blood loss, and postoperative complications. Seventy-one patients were included in the study. Of them, 59.2% (n = 42) underwent an LSTC and 44.6% (n = 29) underwent an OTC. The LSTC cohort was more likely to have a day-surgery case with a same-day discharge (33.3% vs. 0%, = 0.009), less blood loss (71.4 ± 82.26 vs. 184.8 ± 234.86, = 0.009), and a shorter operative duration (187.86 ± 68.74 vs. 258.62 ± 134.52 min, = 0.008). Furthermore, BDI was significantly lower in the LSTC group (2.4% vs. 17.2%, = 0.045). However, there were no significant differences between the two groups concerning intraoperative drain placement, peri-cholecystic fluid collection, bile leak, and other complications ( > 0.05). : LSTC is a safe and effective alternative to OTC for challenging gallbladder cases. Further studies with larger sample sizes and longer follow-up periods as well as different study designs are warranted.
困难的胆囊解剖增加了腹腔镜胆囊切除术（LC）过程中胆管损伤（BDI）和其他并发症的风险。本研究比较了腹腔镜胆囊次全切除术（LSTC）和开腹胆囊全切除术（OTC）治疗困难性胆囊切除术的结果。本回顾性分析了 2016 年至 2023 年的胆囊手术（LSTC 或 OTC），包括患者人口统计学、手术细节和术后结果。主要结果是 BDI 的发生率。次要结果包括手术持续时间、出血量和术后并发症。 本研究共纳入 71 例患者。其中，59.2%（n=42）行 LSTC，44.6%（n=29）行 OTC。LSTC 组更有可能行日间手术并当日出院（33.3% vs. 0%，=0.009），出血量更少（71.4±82.26 比 184.8±234.86，=0.009），手术时间更短（187.86±68.74 比 258.62±134.52 min，=0.008）。此外，LSTC 组 BDI 发生率显著降低（2.4% vs. 17.2%，=0.045）。然而，两组在术中引流管放置、胆囊周围积液、胆漏和其他并发症方面无显著差异（>0.05）。结论：LSTC 是治疗困难性胆囊病例的一种安全有效的替代方法。需要进一步开展样本量更大、随访时间更长以及不同研究设计的研究。
