Risk Factors Predicting Conversion to Laparoscopic Subtotal Cholecystectomy and Post-operative Outcomes from a High-Volume Centre

Background: Laparoscopic subtotal cholecystectomy (LSC) is utilized as a safe and feasible alternative for difficult cholecystectomies to avoid bile duct injury and can aid in avoiding conversion to open surgery. This study assesses the risk factors and outcomes of patients who underwent LSC. Methods: A retrospective analysis was conducted of patients undergoing LSC from September 2019 to August 2021. Relative clinical and operative factors as well as postoperative outcomes were analysed. Results: There were 631 consecutive cholecystectomies included, 53 of which required LSC. Nine (16.9%) used the reconstituting technique and 43 (81.8%) were fenestrating LSC, one procedure not specified. High BMI (26.4%) and previous endoscopic retrograde cholangiopancreatography (ERCP) (18.9%) were the most common indicators for expected difficulty. Severe inflammation (58.5%) followed by extensive adhesions (52.8%) were the leading causes for conversion to LSC. Aberrant biliary anatomy was the strongest predictor of conversion, and an emergency operation was more likely to require a LSC. The presence of a contracted gallbladder, severe inflammation, gallbladder empyema and extensive adhesions were all independently associated with LSC (all p < 0.05). Postoperative complications were recorded in 26.4% of patients. Fifteen percent of patients had postoperative bile leaks; five resolved spontaneously while three required intervention with ERCP. There were eight Clavien-Dindo Grade III complications, three (5.7%) required ERCPs and five (9.4%) required relook laparotomies. There was one mortality. Conclusions: LSC is a safe alternative that should be utilized in the management of complex gallbladder pathology. Post-operative bile leak was not a major clinical issue in our setting

Grantor

Division of General Surgery

Year dc:date.issued

2023

Author dc:creator

• Booyse, Karien

Advisor dc:contributor.advisor

• Kloppers, Jacobus

• Surgery

Handle dc:identifier.uri

http://hdl.handle.net/11427/37971

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/37971