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Efficacy of bailout surgery for preventing intraoperative biliary injury in acute cholecystitis

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Abstract

Background

Bailout surgery (BOS; partial cholecystectomy, open conversion, and fundus-first approach) has been recommended for difficult cases to ensure safe performance of cholecystectomy. However, the efficacy of BOS for preventing intraoperative massive bleeding and bile duct injury (BDI) remains unclear, especially in the context of acute cholecystitis (AC). This study aimed to retrospectively validate the feasibility of BOS for AC.

Methods

We enrolled 479 patients who underwent emergency cholecystectomies for AC between 2011 and 2021. Univariate and multivariate analyses were performed to detect the risk factors for BOS in patients with AC. Perioperative variables were compared between patients who underwent total cholecystectomy (TC) and those who underwent BOS. Propensity score matching analysis was performed to compare the two groups.

Results

Significant differences in American Society of Anesthesiologists physical status and Charlson Comorbidity Index scores, TG18 severity grading, white blood cell count, and albumin and C-reactive protein (CRP) levels were found between the TC and BOS groups. Preoperative CT imaging demonstrated severe inflammation evidenced by gallbladder wall thickness, enhancement of the liver bed, and duodenal edema in the BOS group compared to the TC group. Postoperative complications were significantly higher in the BOS group than in the TC group. Further, BDI was completely prevented by BOS. Multivariate analysis identified TG18 grade ≥ II, CRP ≥ 7.7, and duodenal edema as independent risk factors for BOS. After PSM analysis, postoperative complications were not worse in patients who underwent BOS rather than TC. Among BOS procedures, laparoscopic BOS (lap-BOS) was the most efficacious in preventing intraoperative blood loss and postoperative bile leakage.

Conclusion

Severity grading > II, elevated CRP levels, or duodenum edema revealed by CT were determined to be risk factors impeding total cholecystectomy. BOS is a safe, feasible, and efficacious procedure for preventing BDI. Among BOS procedures, lap-BOS showed better postoperative outcomes.

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References

  1. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD006231

    Article  PubMed  PubMed Central  Google Scholar 

  2. Roulin D, Saadi A, Di Mare L, Demartines N, Halkic N (2016) Early versus delayed cholecystectomy for acute cholecystitis, are the 72 hours still the rule?: a randomized trial. Ann Surg 264:717–722

    Article  PubMed  Google Scholar 

  3. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, Iwashita Y, Hibi T, Pitt HA, Umezawa A, Asai K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WS, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, Nakamura M, Horiguchi A, Wakabayashi G, Cherqui D, de Santibañes E, Shikata S, Noguchi Y, Ukai T, Higuchi R, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Shibao K, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Hirata K, Inui K, Sumiyama Y, Yamamoto M (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25:55–72

    Article  PubMed  Google Scholar 

  4. Gerard J, Luu MB, Poirier J, Deziel DJ (2018) Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases. Surg Endosc 32:3943–3948

    Article  PubMed  Google Scholar 

  5. Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M, Sugrue M, Ansaloni L (2015) Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg 18:196–204

    Article  PubMed  Google Scholar 

  6. Honda G, Iwanaga T, Kurata M, Watanabe F, Satoh H, Iwasaki K (2009) The critical view of safety in laparoscopic cholecystectomy is optimized by exposing the inner layer of the subserosal layer. J Hepatobiliary Pancreat Surg 16:445–449

    Article  PubMed  Google Scholar 

  7. Hirohata R, Abe T, Amano H, Hanada K, Kobayashi T, Ohdan H, Noriyuki T, Nakahara M (2020) Identification of risk factors for open conversion from laparoscopic cholecystectomy for acute cholecystitis based on computed tomography findings. Surg Today 50:1657–1663

    Article  CAS  PubMed  Google Scholar 

  8. Shimoda M, Udo R, Imasato R, Oshiro Y, Suzuki S (2021) What are the risk factors of conversion from total cholecystectomy to bailout surgery? Surg Endosc 35:2206–2210

    Article  PubMed  Google Scholar 

  9. Li J, Frilling A, Nadalin S, Broelsch CE, Malago M (2012) Timing and risk factors of hepatectomy in the management of complications following laparoscopic cholecystectomy. J Gastrointest Surg 16:815–820

    Article  CAS  PubMed  Google Scholar 

  10. Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ (2019) Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 33:724–730

    Article  PubMed  Google Scholar 

  11. Wakabayashi G, Iwashita Y, Hibi T, Takada T, Strasberg SM, Asbun HJ, Endo I, Umezawa A, Asai K, Suzuki K, Mori Y, Okamoto K, Pitt HA, Han HS, Hwang TL, Yoon YS, Yoon DS, Choi IS, Huang WS, Giménez ME, Garden OJ, Gouma DJ, Belli G, Dervenis C, Jagannath P, Chan ACW, Lau WY, Liu KH, Su CH, Misawa T, Nakamura M, Horiguchi A, Tagaya N, Fujioka S, Higuchi R, Shikata S, Noguchi Y, Ukai T, Yokoe M, Cherqui D, Honda G, Sugioka A, de Santibañes E, Supe AN, Tokumura H, Kimura T, Yoshida M, Mayumi T, Kitano S, Inomata M, Hirata K, Sumiyama Y, Inui K, Yamamoto M (2018) Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 25:73–86

    Article  PubMed  Google Scholar 

  12. Kim Y, Wima K, Jung AD, Martin GE, Dhar VK, Shah SA (2017) Laparoscopic subtotal cholecystectomy compared to total cholecystectomy: a matched national analysis. J Surg Res 218:316–321

    Article  PubMed  Google Scholar 

  13. Dutch Pancreatitis Study Grp, da Costa DW, Schepers NJ, Bouwense SA, Hollemans RA, van Santvoort HC, Bollen TL, Consten EC, van Goor H, Hofker S, Gooszen HG, Boerma D, Besselink MG (2019) Predicting a ‘difficult cholecystectomy’ after mild gallstone pancreatitis. HPB 21:827–833

    Article  Google Scholar 

  14. Schrenk P, Woisetschlager R, Rieger R, Wayand WU (1998) A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables. Surg Endosc 12:148–150

    Article  CAS  PubMed  Google Scholar 

  15. Nassar AHM, Hodson J, Ng HJ, Vohra RS, Katbeh T, Zino S, Griffiths EA (2020) Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc 34:4549–4561

    Article  PubMed  Google Scholar 

  16. Cengiz Y, Lund M, Janes A, Lundell L, Sandblom G, Israelsson L (2019) Fundus first as the standard technique for laparoscopic cholecystectomy. Sci Rep 9:18736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Conrad C, Wakabayashi G, Asbun HJ, Dallemagne B, Demartines N, Diana M, Fuks D, Giménez ME, Goumard C, Kaneko H, Memeo R, Resende A, Scatton O, Schneck AS, Soubrane O, Tanabe M, van den Bos J, Weiss H, Yamamoto M, Marescaux J, Pessaux P (2017) IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 24:603–615

    Article  PubMed  Google Scholar 

  18. Chavez-Villa M, Dominguez-Rosado I, Figueroa-Mendez R, De Los S-P, Mercado MA (2021) Subtotal cholecystectomy after failed critical view of safety is an effective and safe bail out strategy. J Gastrointest Surg 25:2553–2561

    Article  PubMed  Google Scholar 

  19. Strasberg SM (2019) A three-step conceptual roadmap for avoiding bile duct injury in laparoscopic cholecystectomy: an invited perspective review. J Hepatobiliary Pancreat Sci 26:123–127

    Article  PubMed  Google Scholar 

  20. Harilingam MR, Shrestha AK, Basu S (2016) Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: a single-centre experience. J Minim Access Surg 12:325–329

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tornqvist B, Stromberg C, Persson G, Nilsson M (2012) Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 345:e6457

    Article  PubMed  PubMed Central  Google Scholar 

  22. Griffiths EA, Hodson J, Vohra RS, Marriott P, Katbeh T, Zino S, Nassar AHM (2019) Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc 33:110–121

    Article  PubMed  Google Scholar 

  23. Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy results of a national survey. Ann Surg 234:549–558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sugrue M, Sahebally SM, Ansaloni L, Zielinski MD (2015) Grading operative findings at laparoscopic cholecystectomy— a new scoring system. World J Emerg Surg 10:14

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank the Center of Life Science at Hiroshima University for the use of their facilities. We would also like to thank all the individuals who contributed to this work.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan

    Tomoyuki Abe, Akihiko Oshita, Nobuaki Fujikuni, Toshio Noriyuki & Masahiro Nakahara

  2. Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Akihiko Oshita, Tsuyoshi Kobayashi, Toshio Noriyuki & Hideki Ohdan

  3. Center for Medical Education Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan

    Minoru Hattori

  4. Department of Gastroenterology, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, Japan

    Keiji Hanada

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  1. Tomoyuki Abe
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  2. Akihiko Oshita
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  3. Nobuaki Fujikuni
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Contributions

TA and AO wrote the manuscript. The remaining authors contributed to data collection, analysis, and interpretation. TA, MN, and AO performed the surgeries. All authors conceived the study, participated in its design and coordination, and helped draft the manuscript. All authors have read and approved the final manuscript for publication.

Corresponding author

Correspondence to Tomoyuki Abe.

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Disclosures

The following authors declare that they have no conflicts of interest: Tomoyuki Abe, MD, PhD; Akihiko Oshita, MD, Ph.D.; Nobuaki Fujikuni, MD, Ph.D.; Minoru Hattori, PhD.; Tsuyoshi Kobayashi, MD, Ph.D.; Keiji Hanada, MD, Ph.D, Toshio Noriyuki, MD, Ph.D.; Hideki Ohdan, MD, Ph.D.; Masahiro Nakahara, MD, Ph.D.

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Abe, T., Oshita, A., Fujikuni, N. et al. Efficacy of bailout surgery for preventing intraoperative biliary injury in acute cholecystitis. Surg Endosc 37, 2595–2603 (2023). https://doi.org/10.1007/s00464-022-09755-0

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