Subtotal Cholecystectomy–“Fenestrating” vs “Reconstituting” Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions - 23/12/15
, Michael J. Pucci, MD, FACS c, L. Michael Brunt, MD, FACS b, Daniel J. Deziel, MD, FACS dAbstract |
Less than complete cholecystectomy has been advocated for difficult operative conditions for more than 100 years. These operations are called partial or subtotal cholecystectomy, but the terms are poorly defined and do not stipulate whether a remnant gallbladder is created. This article briefly reviews the history and development of the procedures and introduces new terms to clarify the field. The term partial is discarded, and subtotal cholecystectomies are divided into “fenestrating” and “reconstituting” types. Subtotal reconstituting cholecystectomy closes off the lower end of the gallbladder, reducing the incidence of postoperative fistula, but creates a remnant gallbladder, which may result in recurrence of symptomatic cholecystolithiasis. Subtotal fenestrating cholecystectomy does not occlude the gallbladder, but may suture the cystic duct internally. It has a higher incidence of postoperative biliary fistula, but does not appear to be associated with recurrent cholecystolithiasis. Laparoscopic subtotal cholecystectomy has advantages but may require advanced laparoscopic skills.
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| Disclosure Information: Nothing to disclose. |
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| Disclosures outside the scope of this work: Dr Brunt receives research support grants from Gore and Karl Storz Endoscopy. |
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| This article is a work product of the SAGES Safe Cholecystectomy Task Force 2015. |
Vol 222 - N° 1
P. 89-96 - janvier 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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