| Abstract [eng] |
Bile duct injuries during laparoscopic cholecystectomy represent a significant number of iatrogenic complications, posing considerable clinical challenges and potential long-term complications to the patient. A primary factor contributing to an increased risk of bile duct injury is failure to accurately identify anatomical structures during surgery. This can happen due to inflamed gallbladder and its adjacent structures, causing tissue edema, fibrosis, and the formation of adhesions. According to the 2020 guidelines of the World Society of Emergency Surgery, subtotal laparoscopic cholecystectomy is one of the recommended surgical approaches in the presence of difficult gallbladder, where the risk of bile duct injury is high. The aim of this study is to systematically review existing literature and evaluate whether subtotal laparoscopic cholecystectomy is a safe and feasible method to prevent iatrogenic bile duct injuries in complicated cholecystectomies. A comprehensive systematic review of the literature following methodological criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed. A total of 26 studies were chosen that met the inclusion criteria and the purpose of the work. The most common indications for subtotal laparoscopic cholecystectomy were acute inflammation of the gallbladder, adhesions within the Calots triangle, and gallstones. The most common complications following the procedure were the development of a biliary fistula, the requirement for endoscopic retrograde cholangiopancreatography in the postoperative period, and intra-abdominal fluid accumulation. Patients who required subtotal cholecystectomy were typically of older age and male. Elevated leukocyte count was associated with increased blood loss during surgery. Based on the results of this systematic review, subtotal laparoscopic cholecystectomy is a safe and feasible method to prevent iatrogenic bile duct injuries in the presence of complicated cholecystitis. Despite the heightened risk of postoperative complications associated with subtotal cholecystectomy when compared to conventional laparoscopic cholecystectomy, in cases of complicated cholecystitis, subtotal laparoscopic cholecystectomy is a safe bailout procedure to prevent bile duct injuries. |
