Open Cholecystectomy for the New Learner-Obstacles and Challenges

Rare Case of a Combined Cholecystocolonic and Cholecystoduodenal Fistula Presenting With Pneumobilia

Background: Cholecystoenteric fistulae are rare complications of gallstone disease, with a reported incidence of 0.5% to 0.9% of cholecystectomies. Cholecystoduodenal is the most common fistula followed by cholecystocolonic fistulae. Summary: We report a case of pneumobilia resulting from a combined cholecystoduodenal and cholecystocolonic fistulae treated with a laparoscopic subtotal cholecystectomy and open repair of the enteric fistulae. Conclusion: Combined cholecystoduodenal and cholecystocolonic fistulae are an extremely rare complication of gallstone disease, and meticulous preoperative planning and operative dexterity are needed to safely manage these unusual fistulae.

Open versus laparoscopic completion cholecystectomy in patients with previous open partial cholecystectomy: a retrospective comparative study

Background

Some patients report recurrence or persistence of their manifestations after cholecystectomy, and retained gallstones may be a relevant etiology for their complaint. Completion cholecystectomy is advised for these cases to alleviate their manifestations. No previous studies have compared the outcomes of open versus laparoscopic outcomes in these patients, especially in patients who had initial open partial procedures. That is why we performed this study to report the perioperative outcomes of the two approaches in such patients.

Methodology

This is a retrospective analysis of 80 patients who had a completion cholecystectomy in the authors' center (40 open and 40 laparoscopic cases) after initial open partial cholecystectomy.

Results

The duration elapsed since the primary procedure had an average of 18 months in the open group and 21 months in the laparoscopic group. Abdominal pain and dyspepsia were the most common presentations. Some patients had stump cholecystitis or jaundice. The intraoperative assessment revealed either the residual gallbladder or a long cystic duct stump. Laparoscopy yielded shorter operative time, earlier oral intake, and shorter hospitalization periods compared to the open approach (P<0.05). The latter was associated with a 20% wound infection rate that was never encountered after laparoscopy (P =0.003).

Conclusion

Previous open partial cholecystectomy does not hinder subsequent laparoscopic completion cholecystectomy. Additionally, laparoscopy is associated with better perioperative outcomes than the open approach.

Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report

A 60-year-old male patient who presented with right upper quadrant (RUQ) pain was diagnosed with acute cholecystitis after an ultrasound of the abdomen revealed multiple gallstones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign. The patient was admitted, administered IV fluids, antibiotics, and pain relief, and scheduled for laparoscopic cholecystectomy. During surgery, an incidental finding of ectopic liver tissue attached to the gallbladder was noted. Histopathology confirmed the presence of chronic cholecystitis and multifaceted cholesterol stones. Normal liver tissue was noted in the ectopic mass. Ectopic liver tissue is defined as liver tissue located outside the main liver parenchyma and is usually asymptomatic. They are usually detected at the time of autopsies, incidentally during surgeries, or during imaging done for other etiologies. They can occur at various sites in the body. Ectopic liver tissue can cause potential complications such as hepatocellular carcinoma and torsion, and in the event that they are incidentally detected, it is advised to remove them. The case report highlights the importance of dealing with incidental findings during laparoscopic cholecystectomy and creating awareness about it.

Therapeutic Effect of Laparoscopic Cholecystectomy on Patients with Cholecystolithiasis Complicated with Chronic Cholecystitis and Postoperative Quality of Life

Objective

To assess the treatment outcome and postoperative quality of life of patients with gallbladder stones and chronic cholecystitis after open cholecystectomy and laparoscopic cholecystectomy.

Methods

Between 2018 and 2020, 108 patients with gallbladder stones and chronic cholecystitis treated in our hospital were assessed for eligibility and randomly recruited. They were concurrently assigned (1 : 1) to receive either open cholecystectomy (control group) or laparoscopic cholecystectomy (study group). Outcome measures include surgical indices, inflammatory response, postoperative complications, and quality of life of patients.

Results

Laparoscopic cholecystectomy was associated with a shorter duration of surgery, intraoperative bleeding, time to first postoperative bowel movement, and postoperative hospital stay versus open cholecystectomy (P < 0.05). The levels of inflammatory factors of all eligible patients were comparable before cholecystectomy (P > 0.05). The patients given laparoscopic cholecystectomy showed lower levels of C-reactive protein (CRP), interleukin (IL)-6, and IL-8 versus those given open cholecystectomy (P < 0.05). Laparoscopic cholecystectomy resulted in a significantly lower incidence of complication (3.56%) versus open cholecystectomy (24.07%) (P < 0.05). The patients had significantly higher physical, psychological, and social function scores after laparoscopic cholecystectomy versus open cholecystectomy (P < 0.05).

Conclusion

Laparoscopic cholecystectomy provides better surgical results, mitigates the inflammatory response, lowers the incidence of complications, and improves the quality of life of patients versus open cholecystectomy, so it is worthy of application in clinical treatment.

Subtotal Cholecystectomy Results in High Peri-operative Morbidity and Its Risk-Profile Should be Emphasised During Consent

BACKGROUND

Subtotal cholecystectomy aims to reduce the likelihood of bile duct injury but risks a multitude of less severe, yet significant complications. The primary aim of the present study was to report peri-operative outcomes of subtotal laparoscopic cholecystectomy (SLC) relative to total laparoscopic cholecystectomy (TLC) to inform the consent process.

METHOD

All laparoscopic cholecystectomies between 2015 and 2020 in one health board were included. The peri-operative outcomes of SLC (n = 87) and TLC (n = 2650) were reported. Pre-operative variables were compared between the two groups to identify risk factors for SLC. The outcomes between the SLC and TLC were compared using univariate, multivariate and propensity analysis.

RESULTS

Risk factors for SLC included higher age, male gender, cholecystitis, increased biliary admissions, ERCP, cholecystostomy and emergency cholecystectomy. Following SLC, rates of post-operative complication (45.9%), imaging (37.9%) intervention (28.7%) and readmission (29.9%) were significant. The risk profile was vastly heightened compared to that of TLC: intra-operative complications (RR 9.0; p < 0.001), post-operative complications [bile leak (RR 58.9; p < 0.001), collection (RR 12.2; p < 0.001), retained stones (RR 7.2; p < 0.001) and pneumonia (RR 5.4; p < 0.001)], post-operative imaging (RR 4.4; p < 0.001), post-operative intervention (RR 12.3; p < 0.001), prolonged PLOS (RR 11.3; p < 0.001) and readmission (RR 4.5; p < 0.001). The findings were consistent using multivariate logistic regression and propensity analysis.

CONCLUSION

The relative morbidity associated with SLC is significant and high-risk patients should be counselled for the peri-operative morbidity of subtotal cholecystectomy.