Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity

Michael E. Lidsky, Paul J. Speicher, Brian Ezekian, Edwin W. Holt, Daniel P. Nussbaum, Anthony W. Castleberry, Alexander Perez, Theodore N. Pappas

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. Methods Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct. After propensity matching, we investigated surgical indications, perioperative outcomes, and the necessity for secondary ERCP, percutaneous drainage, and completion cholecystectomy. Results 65 (0.39%) patients underwent subtotal cholecystectomy; 54 (83.1%) began laparoscopically, of which 30 (55.6%) required conversion to laparotomy. Subtotal cholecystectomy, performed more frequently for acute cholecystitis (70.8% vs 34.6%), was associated with extended hospitalizations (4 d vs 2 d) and frequent surgical site infections (20% vs 4.6%). 25 (38.5%) subtotal cholecystectomy patients required ≥1 secondary intervention, and compared to standard cholecystectomy, underwent higher rates postoperative ERCP (30.8% vs 5.4%), percutaneous drainage (9.2% vs 1.5%), and completion cholecystectomy (6.2% vs 0%) [all P < 0.05]. Discussion Subtotal cholecystectomy fails to control the cystic duct, resulting in significant morbidity. Most do not require completion cholecystectomy; however, patients demand close observation and, frequently, secondary interventions.

Original languageEnglish (US)
Pages (from-to)547-556
Number of pages10
JournalHPB
Volume19
Issue number6
DOIs
StatePublished - Jun 1 2017
Externally publishedYes

Fingerprint

Cystic Duct
Cholecystectomy
Gallbladder
Morbidity
Endoscopic Retrograde Cholangiopancreatography
Drainage
Surgical Wound Infection
Acute Cholecystitis
Laparotomy
Hospitalization

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Lidsky, M. E., Speicher, P. J., Ezekian, B., Holt, E. W., Nussbaum, D. P., Castleberry, A. W., ... Pappas, T. N. (2017). Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity. HPB, 19(6), 547-556. https://doi.org/10.1016/j.hpb.2017.02.441

Subtotal cholecystectomy for the hostile gallbladder : failure to control the cystic duct results in significant morbidity. / Lidsky, Michael E.; Speicher, Paul J.; Ezekian, Brian; Holt, Edwin W.; Nussbaum, Daniel P.; Castleberry, Anthony W.; Perez, Alexander; Pappas, Theodore N.

In: HPB, Vol. 19, No. 6, 01.06.2017, p. 547-556.

Research output: Contribution to journalArticle

Lidsky, ME, Speicher, PJ, Ezekian, B, Holt, EW, Nussbaum, DP, Castleberry, AW, Perez, A & Pappas, TN 2017, 'Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity', HPB, vol. 19, no. 6, pp. 547-556. https://doi.org/10.1016/j.hpb.2017.02.441
Lidsky, Michael E. ; Speicher, Paul J. ; Ezekian, Brian ; Holt, Edwin W. ; Nussbaum, Daniel P. ; Castleberry, Anthony W. ; Perez, Alexander ; Pappas, Theodore N. / Subtotal cholecystectomy for the hostile gallbladder : failure to control the cystic duct results in significant morbidity. In: HPB. 2017 ; Vol. 19, No. 6. pp. 547-556.
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abstract = "Background Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. Methods Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct. After propensity matching, we investigated surgical indications, perioperative outcomes, and the necessity for secondary ERCP, percutaneous drainage, and completion cholecystectomy. Results 65 (0.39{\%}) patients underwent subtotal cholecystectomy; 54 (83.1{\%}) began laparoscopically, of which 30 (55.6{\%}) required conversion to laparotomy. Subtotal cholecystectomy, performed more frequently for acute cholecystitis (70.8{\%} vs 34.6{\%}), was associated with extended hospitalizations (4 d vs 2 d) and frequent surgical site infections (20{\%} vs 4.6{\%}). 25 (38.5{\%}) subtotal cholecystectomy patients required ≥1 secondary intervention, and compared to standard cholecystectomy, underwent higher rates postoperative ERCP (30.8{\%} vs 5.4{\%}), percutaneous drainage (9.2{\%} vs 1.5{\%}), and completion cholecystectomy (6.2{\%} vs 0{\%}) [all P < 0.05]. Discussion Subtotal cholecystectomy fails to control the cystic duct, resulting in significant morbidity. Most do not require completion cholecystectomy; however, patients demand close observation and, frequently, secondary interventions.",
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AU - Speicher, Paul J.

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AU - Holt, Edwin W.

AU - Nussbaum, Daniel P.

AU - Castleberry, Anthony W.

AU - Perez, Alexander

AU - Pappas, Theodore N.

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N2 - Background Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. Methods Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct. After propensity matching, we investigated surgical indications, perioperative outcomes, and the necessity for secondary ERCP, percutaneous drainage, and completion cholecystectomy. Results 65 (0.39%) patients underwent subtotal cholecystectomy; 54 (83.1%) began laparoscopically, of which 30 (55.6%) required conversion to laparotomy. Subtotal cholecystectomy, performed more frequently for acute cholecystitis (70.8% vs 34.6%), was associated with extended hospitalizations (4 d vs 2 d) and frequent surgical site infections (20% vs 4.6%). 25 (38.5%) subtotal cholecystectomy patients required ≥1 secondary intervention, and compared to standard cholecystectomy, underwent higher rates postoperative ERCP (30.8% vs 5.4%), percutaneous drainage (9.2% vs 1.5%), and completion cholecystectomy (6.2% vs 0%) [all P < 0.05]. Discussion Subtotal cholecystectomy fails to control the cystic duct, resulting in significant morbidity. Most do not require completion cholecystectomy; however, patients demand close observation and, frequently, secondary interventions.

AB - Background Outcomes following the inability to control the cystic duct due to a hostile triangle of Calot during cholecystectomy remain unknown. The purpose of this study was to analyze the safety and efficacy of subtotal cholecystectomy, with attention to the necessity for secondary interventions. Methods Sixteen thousand five hundred ninety six cholecystectomies from January 2002 to August 2014 were reviewed, identifying patients managed with subtotal cholecystectomy, defined as the inability to isolate/transect the cystic duct. After propensity matching, we investigated surgical indications, perioperative outcomes, and the necessity for secondary ERCP, percutaneous drainage, and completion cholecystectomy. Results 65 (0.39%) patients underwent subtotal cholecystectomy; 54 (83.1%) began laparoscopically, of which 30 (55.6%) required conversion to laparotomy. Subtotal cholecystectomy, performed more frequently for acute cholecystitis (70.8% vs 34.6%), was associated with extended hospitalizations (4 d vs 2 d) and frequent surgical site infections (20% vs 4.6%). 25 (38.5%) subtotal cholecystectomy patients required ≥1 secondary intervention, and compared to standard cholecystectomy, underwent higher rates postoperative ERCP (30.8% vs 5.4%), percutaneous drainage (9.2% vs 1.5%), and completion cholecystectomy (6.2% vs 0%) [all P < 0.05]. Discussion Subtotal cholecystectomy fails to control the cystic duct, resulting in significant morbidity. Most do not require completion cholecystectomy; however, patients demand close observation and, frequently, secondary interventions.

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