The Safety of Subtotal over Total Cholecystectomy: A Systematic Review
Published: 2024-06-25
Page: 167-175
Issue: 2024 - Volume 7 [Issue 2]
Adil Mahgoub Musa Mohamed *
Hafer Albatin Central Hospital, Saudi Arabia.
Faisal Muhammad Shayeb Al-Dour
Hafer Albatin Central Hospital, Saudi Arabia.
Eman Ibrahim Abdalla Osman
Hafer Albatin Central Hospital, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Subtotal cholecystectomy (STC) is a promising alternative to total cholecystectomy (TC) for gallbladder procedures, with research showing a reduced incidence of bile duct damage. However, concerns persist regarding residual gallbladder tissue post-STC, potentially leading to serious postoperative complications like bile leakage. This study aimed to critically assess the safety profile of STC versus TC based on a thorough analysis of the current literature. A systematic review was conducted, involving eight studies from 2012-2024, involving human subjects. The review found that STC demonstrated distinct advantages and disadvantages compared to TC, manifesting differences in complication rates, postoperative outcomes, and healthcare resource utilization. Cumulative evidence suggests that STC may present advantages in select scenarios, such as a reduced risk of common bile duct injury. However, STC is also associated with elevated rates of certain postoperative complications, underscoring the need for careful consideration when opting for this approach. In contrast, TC appears to demonstrate lower rates of specific complications like bile leaks and subhepatic fluid collections. Surgeons should carefully consider the trade-offs between STC and TC based on the complexity of the cholecystectomy case and the associated risks and benefits of each procedure. Further research and ongoing evaluation are necessary to refine the understanding of the safety profile of subtotal cholecystectomy.
Keywords: Difficult gallbladder, subtotal cholecystectomy, total cholecystectomy
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References
Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for difficult gallbladders: Systematic review and meta-analysis. JAMA Surg. 2015;150(2):159-168. DOI:10.1001/jamasurg.2014.1219 [PubMed] [CrossRef] [Google Scholar]
Nakajima J, Sasaki A, Obuchi T, Baba S, Nitta H, Wakabayashi G. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today. 2009;39(10): 870-875. [PubMed]
Van Dijk AH, Donkervoort SC, Lameris W, et al. Short- and long-term outcomes after a reconstituting and fenestrating subtotal cholecystectomy. J Am Coll Surg. 2017; 225(3):371-379. DOI:10.1016/j.jamcollsurg.2017.05.016 [PubMed] [CrossRef] [Google Scholar]
Sabour AF, Matsushima K, Love BE, et al. Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis. Surgery. 2020;167(3):569-574. DOI: 10.1016/j.surg.2019.11.004 [PubMed] [CrossRef] [Google Scholar]
Strasberg SM. A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: An invited perspective review. J Hepatobiliary Pancreat Sci. 2019;26(4):123–7. DOI: 10.1002/jhbp.616 [PubMed] [CrossRef] [Google Scholar]
Lunevicius R. Review of the literature on partial resections of the gallbladder, 1898–2022: The outline of the conception of subtotal cholecystectomy and a suggestion to use the terms subtotal open-tract cholecystectomy and subtotal closed-tract cholecystectomy. J Clin Med. 2023;12(3): 1230. DOI: 10.3390/jcm12031230 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. World society of emergency surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):1–26. DOI: 10.1186/s13017-020-00336-x [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Gupta V, Jain G. Safe laparoscopic cholecystectomy: Adoption of universal culture of safety in cholecystectomy. World J Gastrointest Surg. (2019) 11(2):62–84. DOI: 10.4240/wjgs.v11.i2.62 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Strasberg SM, Pucci MJ, Deziel DJ, Brunt LM. Subtotal cholecystectomy e fenestrating vs reconstituting subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg. 2016;222(1):89–96. DOI: 10.1016/j.jamcollsurg.2015.09.019 [PubMed] [CrossRef] [Google Scholar]
Ramírez-Giraldo, Camilo et al. State of the art in subtotal cholecystectomy: An overview. Frontiers in Surgery. 2023;10: 1142579. DOI: 10.3389/fsurg.2023.1142579
Braschi, Caitlyn et al. Early outcomes of subtotal vs total cholecystectomy for acute cholecystitis. JAMA Surgery. 2022; 157(11):1062–1064. DOI: 10.1001/jamasurg.2022.3146
Koo Sylvia SJ et al. Subtotal vs total cholecystectomy for difficult gallbladders: A systematic review and meta-analysis. American Journal of Surgery. 2024;229: 145-150. DOI: 10.1016/j.amjsurg.2023.12.022
Martinez, Brian et al. Evaluating clinical outcomes of laparoscopic subtotal and total cholecystectomy for complicated acute cholecystitis: A systematic review and meta-analysis. The American Surgeon. 2024;90(3):436-444. DOI: 10.1177/00031348231216482
Kaplan Daniel et al. Subtotal cholecystectomy and open total cholecystectomy: Alternatives in complicated cholecystitis. The American Surgeon. 2014;80(10):953-5.
Davis Brian et al. Subtotal cholecystectomy versus total cholecystectomy in complicated cholecystitis. The American Surgeon. 2012;78(7):814-7.
Kim Young et al. Laparoscopic subtotal cholecystectomy compared to total cholecystectomy: A matched national analysis. The Journal of Surgical Research. 2017;218:316-321. DOI: 10.1016/j.jss.2017.06.047
Goyal A, Kachroo SL, Choudhury D, et al. Subtotal cholecystectomy versus total cholecystectomy: A systematic review and meta-analysis. Surg Endosc. 2020;34(12): 5412-5421.
Alshamrani A, Alshamrani M, Alshamrani S, Alshamrani A, Alshamrani S. Comparison of subtotal and total cholecystectomy in Saudi Arabia: A retrospective analysis. Saudi J Med Med Sci. 2020;8(1):27-32. DOI:10.4103/sjmms.sjmms_97_19