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Subtotal Cholecystectomy After Failed Critical View of Safety Is an Effective and Safe Bail Out Strategy

Journal of Gastrointestinal Surgery volume 25, pages 2553–2561 (2021)Cite this article

Abstract

Background

Bile duct injury (BDI) is accompanied by significant morbidity and long-term impact in quality of life. Subtotal cholecystectomy (STC) is an alternative to prevent this outcome but is associated with other complications. The aim of this work is to demonstrate that BDI associated morbidity exceeds STC associated morbidity, underscoring STC as a reasonable bail out strategy.

Methods

We compared 115 patients who underwent STC with 293 patients who were referred to our center with BDI type E1–E3 and underwent surgical repair. The groups were comparable because in both instances the surgeon had the opportunity to decide not to perform a total cholecystectomy once critical view of safety (CVS) was not achieved.

Results

Bile leakage was found in 21% of the STC group with only one BDI (0.9%). More Accordion ≥ 4 were found in the STC group (10.4% vs 4.8%, p = 0.035); however, reoperations were more frequent in the BDI group (8.2% vs 0.9%, p = 0.006). No patient in the STC group required reintervention for completion cholecystectomy. After 3.8 years follow-up, 2.4% of patients had secondary biliary cirrhosis in the BDI group; none in the STC group.

Conclusions

Despite complications of STC, morbidity associated with BDI is much higher due to high long-term reoperation rate, in addition to secondary biliary cirrhosis. STC is a safe alternative that can prevent BDI if properly and timely performed in the context of difficult cholecystectomy.

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Acknowledgements

The authors acknowledge Isabel Velázquez for her helpful suggestions in language editing and writing assistance.

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Affiliations

  1. Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Mariana Chávez-Villa, Ismael Dominguez-Rosado, Aldair De los Santos-Pérez & Miguel Angel Mercado

  2. Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Sección XVI, 14080, Tlalpan, Mexico City, México

    Rodrigo Figueroa-Méndez

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  1. Mariana Chávez-Villa
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Correspondence to Ismael Dominguez-Rosado.

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Drs. Chávez-Villa, Domínguez-Rosado, Figueroa-Méndez, De los Santos-Pérez, and Mercado have no conflicts of interest or financial ties to disclose.

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Chávez-Villa, M., Dominguez-Rosado, I., Figueroa-Méndez, R. et al. Subtotal Cholecystectomy After Failed Critical View of Safety Is an Effective and Safe Bail Out Strategy. J Gastrointest Surg 25, 2553–2561 (2021). https://doi.org/10.1007/s11605-021-04934-1

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  • DOI: https://doi.org/10.1007/s11605-021-04934-1

Keywords

  • Difficult gallbladder
  • Subtotal cholecystectomy
  • Bail out strategy
  • Bile duct injury