A Study of Combined Laparoscopic-Endoscopic Approach for Complex Cholecystic Disease in A Same Operative Session With 3 Ports Technique: A Safe Bailout Strategy
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Background: Laparoscopic cholecystectomy is the gold standard for gallbladder disease. However, dense adhesions, severe inflammation, empyema, gangrene, impacted stones, choledocholithiasis and anatomical anomalies may render conventional laparoscopic cholecystectomy unsafe.
Methodology: This is a retrospective observational study included 130 patients who underwent laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy between July 2012 and January 2025 at a tertiary referral centre. Preoperative evaluation included clinical assessment, laboratory investigations, ultrasonography in 100 (76.92%) or ultrasonography with magnetic resonance cholangiopancreatography in 30 (23.08%). Outcomes included operative details, postoperative recovery, complications and hospital stays. Statistical analysis utilized Chi-square test, Fisher’s exact test, Student’s t-test and one-way ANOVA with p < 0.05 considered significant.
Results: Laparoscopic cholecystectomy was completed in 85 (65.38%), laparoscopic subtotal cholecystectomy was required in 43 (33.08%) and open conversion occurred in 2 (1.54%). Controlled bile leak developed in 53 (40.77%), resolving spontaneously in 35 (66.04%) within 15 to 21 days. Mean operative time was (2.14 ± 0.75) hours and mean hospital stay was (1.86 ± 1.0) days. Overall morbidity was 8 (6.15%), with complications including common bile duct stricture in 2 (1.54%), common bile duct injury in 1 (0.77%), hepatic artery injury in 1 (0.77%) and mortality in 1 (0.77%) from cardiac arrest unrelated to surgery.
Conclusion: Laparoscopic cholecystectomy, including laparoscopic subtotal cholecystectomy with mucosectomy and endoscopic retrograde cholangiopancreatography with common bile duct stenting when indicated, is a safe and effective approach in both acute and chronic cholecystitis, even in complex gallbladder cases which are technically difficult cases.
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- Journal: 3065-9892 (ISSN)
Dates
- Accepted
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2025-09-25
References
- 1. Ie M, Katsura M, Kanda Y, Kato T, Sunagawa K, Mototake H. Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis. BMC Surg. 2021;21(1):386. doi:10.1186/s12893-021-01387-w PubMed | Crossref | Google Scholar
- 2. Strasberg SM, Pucci MJ, Brunt LM, Deziel DJ. Subtotal Cholecystectomy-"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
- 3. Jara G, Rosciano J, Barrios W, et al. Laparoscopic subtotal cholecystectomy: a surgical alternative to reduce complications in complex cases. Colecistectomía laparoscópica subtotal como alternativa quirúrgica segura en casos complejos. Cir Esp. 2017;95(8):465-470. doi:10.1016/j.ciresp.2017.07.013 PubMed | Crossref | Google Scholar
- 4. Ben Hmida W, Jerraya H, Nasseh S, Haloui N, Khalfallah M, Nouira R. The complications of subtotal cholecystectomy: A case report. Int J Surg Case Rep. 2021;83:105950. doi:10.1016/j.ijscr.2021.105950 PubMed | Crossref | Google Scholar
- 5. Lunevicius R. Laparoscopic subtotal cholecystectomy: a classification, which encompasses the variants, technical modalities, and extent of resection of the gallbladder. Ann R Coll Surg Engl. 2020;102(4):315-317. doi:10.1308/rcsann.2020.0007 PubMed | Crossref | Google Scholar
- 6. 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
- 7. Lucocq J, Hamilton D, Scollay J, Patil P. Subtotal Cholecystectomy Results in High Peri-operative Morbidity and Its Risk-Profile Should be Emphasised During Consent. World J Surg. 2022;46(12):2955-2962. doi:10.1007/s00268-022-06737-0 PubMed | Crossref | Google Scholar
- 8. Al-Azzawi M, Abouelazayem M, Parmar C, et al. A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?. Ann R Coll Surg Engl. 2024;106(3):205-212. doi:10.1308/rcsann.2023.0008 PubMed | Crossref | Google Scholar
- 9. Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54. doi:10.1002/jhbp.515 PubMed | Crossref | Google Scholar
- 10. Montalvo-Javé EE, Contreras-Flores EH, Ayala-Moreno EA, Mercado MA. Strasberg's Critical View: Strategy for a Safe Laparoscopic Cholecystectomy. Euroasian J Hepatogastroenterol. 2022;12(1):40-44. doi:10.5005/jp-journals-10018-1353 PubMed | Crossref | Google Scholar
- 11. Spivak H, Takla H, McEnaney P, Luhrs A. Robotic Acute Care Surgery. SAGES Webmaster. 2025. https://vimeo.com/1082011919?share=copy