Comparison of Outcomes Between Subtotal Fenestrating Cholecystectomy and Open Conversion Cholecystectomy in Cases of Frozen Calot’s Triangle; A Single Centre Experience

Sarah Tauseef Bukhari; Nasir Mehmood  Wattoo; Waseem Ahmed  Khan; Mubashra  Badar; Romassa  Javed; Sana  Zahid

doi:10.51253/pafmj.v76iSUPPL-2.12370

Authors

Sarah Tauseef Bukhari Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Nasir Mehmood Wattoo Department of General Surgery, Army Liver Transplant Unit/Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Waseem Ahmed Khan Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Mubashra Badar Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Romassa Javed Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Sana Zahid Department of General Surgery, Pak-Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-2.12370

Keywords:

Frozen calot’s triangle, Laparoscopic subtotal fenestrating cholecystectomy, length of stay, Open conversion cholecystectomy

Abstract

Objective: To compare the outcomes of laparoscopic subtotal fenestrating cholecystectomy (LSFC) and open conversion cholecystectomy (OCC) performed for difficult gallbladder surgery with frozen calot’s triangle (FCT).

Study Design: Prospective comparative study.

Place and Duration of Study: Department of General Surgery, Pak-Emirates Military Hospital Rawalpindi, Pakistan from Jan 2023 to Jan 2024.

Methodology: The study population included adult patients who underwent laparoscopic cholecystectomy for gallbladder pathology. The study included a total of eighty-six (n=86) patients. 43 patients underwent LSFC and 43 patients underwent OCC because of FCT. Both groups were compared in terms of Operation time, intra-operative complications, postoperative outcomes, and length of stay (LOS) in the hospital.

Results: The mean age of eighty-six (n=86) patients was 47.70±0.67 years, including 60(69.8%) males and 26(30.2%) females. Patients who underwent LSFC had operation time 91.90±10.32 minutes, length of stay in hospital 4.86±0.70 days, and biliary fistula was formed in 8(18.60%) patients. Patients who underwent OCC had operation time 112.34±12.45 minutes, length of stay in hospital 7.67±0.96 days, bile duct injury in 2(4.65%) patients and formation of biliary fistula in 1(2.32%) patients.

Conclusion: LSFC is associated with reduced operation time, decrease LOS in hospital and lesser incidence of bile duct injury as compared to OCC. However, the incidence of formation of biliary fistula was more with LSFC.

Downloads

Download data is not yet available.

References

1. Hassler KR, Collins JT, Philip K, Jones MW. Laparoscopic Cholecystectomy. Treasure Island (FL): StatPearls Publishing; 2023.

2. Ale AF, Peter SD, Ismaila BO, Misauno MA. Laparoscopic Cholecystectomy in Jos: Prospects and Perspectives. J West Afr Coll Surg 2024; 14(1): 54-58.

http://doi.org/10.4103/jwas.jwas_57_23

3. Li ZZ, Guan LJ, Ouyang R, Chen ZX, Ouyang GQ, Jiang HX. Global, regional, and national burden of gallbladder and biliary diseases from 1990 to 2019. World J Gastrointest Surg 2023;15(11):2564-2578. http://doi.org/10.4240/wjgs.v15.i11.2564

4. Sharma S, Walia BS, Randhawa M, Sharma A, Dugg P, Pannu JS. Histopathological changes in gall bladder mucosa in relation to the number, and size of gallstones, and analysis of the findings in the context of age distribution of the patients: A perspective. Ann Hepatobiliary Pancreat Surg 2023; 27(3): 277-286. http://doi.org/10.14701/ahbps.23-010

5. Jones MW, Guay E, Deppen JG. Open Cholecystectomy. Treasure Island (FL): StatPearls Publishing; 2024.

6. Sun J, Xie TG, Ma ZY, Wu X, Li BL. Current status and progress in laparoscopic surgery for gallbladder carcinoma. World J Gastroenterol 2023; 29(16): 2369-2379.

http://doi.org/10.3748/wjg.v29.i16.2369

7. Pal A, Ahluwalia PS, Sachdeva K, Kashyap R. Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre. Cureus 2023; 15(3): e35767.

http://doi.org/10.7759/cureus.35767

8. Chin X, Mallika Arachchige S, Orbell-Smith J, Wysocki AP. Preoperative and Intraoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Systematic Review of 30 Studies. Cureus 2023; 15(10): e47774.

http://doi.org/10.7759/cureus.47774

9. Thapar, VB, Thapar, PM, Goel R. Evaluation of 30-day morbidity and mortality of laparoscopic cholecystectomy: a multicenter prospective observational Indian Association of Gastrointestinal Endoscopic Surgeons (IAGES) Study. Surg Endosc 2023; 37: 2611–2625.

https://doi.org/10.1007/s00464-022-09659-z

10. Duca S, Bãlã O, Al-Hajjar N. Laparoscopic cholecystectomy: incidents and complications. A retrospective analysis of 9542 consecutive laparoscopic operations. Int Hep Pancreat Biliary Assoc 2003; 5(3): 152-158.

http://doi.org/10.1080/13651820310015293

11. Yildirim AC 4th, Zeren S, Ekici MF, Yaylak F, Algin MC, Arik O. Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy. Cureus 2022; 14(2): e22441.

http://doi.org/10.7759/cureus.22441

12. Kaushik R, Sharma R, Batra R, Yadav TD, Attri AK, Kaushik SP. Laparoscopic cholecystectomy: an Indian experience of 1233 cases. J Laparoendosc Adv Surg Tech 2002; 12(1): 21-25.

http://doi.org/10.1089/109264202753486885

13. Grossman H, Holder KG, Freedle C, Dhanasekara CS, Dissanaike S. Comparing Outcomes of Sub-Total Cholecystectomy Versus Open Cholecystectomy as Bailout Procedures for the Difficult Gallbladder. Am Surg 2023; 89(12): 5372-5378. http://doi.org/10.1177/00031348221148345

14. Hassan AM. Preoperative predictive risk factors of difficult laparoscopic cholecystectomy. Egypt J Surg 2021; 40(2): 536-543.

http://doi.org/10.4103/ejs.ejs_7_21

15. Turaga AH. Enhanced Recovery After Surgery (ERAS) Protocols for Improving Outcomes for Patients Undergoing Major Colorectal Surgery. Cureus 2023; 15(7): e41755.

http://doi.org/10.7759/cureus.41755

16. Terho P, Sallinen V, Lampela H, Harju J, Koskenvuo L, Mentula P. The Critical View of Safety in Laparoscopic Cholecystectomy: User Trends Among Residents and Consultants. Surg Laparosc Endosc Percutan Tech 2022; 32(4): 453-461.

http://doi.org/10.1097/SLE.0000000000001077

17. Song ST, Shi J, Wang XH. Prevalence and risk factors for gallstone disease: A population-based cross-sectional study. J Dig Dis 2020; 21(4): 237-245.

http://doi.org/10.1111/1751-2980.12857

18. Akcakaya A, Okan I, Bas G, Sahin G, Sahin M. Does the Difficulty of Laparoscopic Cholecystectomy Differ Between Genders?. Indian J Surg 2015; 77(Suppl 2): 452-456.

http://doi.org/10.1007/s12262-013-0872-x

19. Joshi HN, Singh AK, Shrestha D, Shrestha I, Karmacharya RM . Clinical Profile of Patients Presenting with Gallstone Disease in University Hospital of Nepal. Kathmandu Univ Med J 2020; 18(71): 256-259.

20. Byskosh A, Stocker B, Liu DY. Subtotal Fenestrating Cholecystectomy: A Safe and Effective Approach to the Difficult Gallbladder. J Surg Res 2023; 282: 191-197.

http://doi.org/10.1016/j.jss.2022.09.014

21. Yildirim AC 4th, Zeren S, Ekici MF, Yaylak F, Algin MC, Arik O et al. Comparison of Fenestrating and Reconstituting Subtotal Cholecystectomy Techniques in Difficult Cholecystectomy. Cureus 2022; 14(2): e22441.

http://doi.org/10.7759/cureus.22441

22. Gao X, Yang TK, Xiao JC, Qu Q, Hong T. Acta Academiae Medicinae Sinicae. Zhongguo Yi Xue Ke Xue Yuan 2021; 43(3): 402-405.

http://doi.org/10.3881/j.issn.1000-503X.13622