Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study

Camilo Ramírez-Giraldo; Danny Conde Monroy; Andrés Isaza-Restrepo; Daniela Ayala; Juliana González-Tamayo; Ana Maria Vargas-Patiño; Luisa Trujillo-Guerrero; Isabella Van-Londoño; Susana Rojas-López

doi:10.1007/s00464-024-10911-x

Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study

Título traducido de la contribución: Colecistectomía laparoscópica subtotal frente a conversión a abierta como procedimiento de rescate: un estudio de cohortes

Camilo Ramírez-Giraldo, Danny Conde Monroy, Andrés Isaza-Restrepo, Daniela Ayala, Juliana González-Tamayo, Ana Maria Vargas-Patiño, Luisa Trujillo-Guerrero, Isabella Van-Londoño, Susana Rojas-López

Producción científica: Contribución a una revista › Artículo de Investigación › revisión exhaustiva

Resumen

Antecedentes: El objetivo de este estudio es evaluar la morbimortalidad en pacientes llevados a conversión a procedimiento abierto (CO) y colecistectomía laparoscópica subtotal (CLS) como procedimientos de rescate al realizar una colecistectomía laparoscópica difícil. Método: Este estudio observacional de cohortes analizó retrospectivamente a los pacientes llevados a SLC o CO como cirugía de rescate durante la colecistectomía laparoscópica difícil entre 2014 y 2022. Se utilizaron modelos de regresión logística univariable y multivariable para identificar factores pronósticos de morbimortalidad. Resultados: Se incluyeron un total de 675 pacientes. De los 675 pacientes (edad media [DE] 63,85 ± 16,00 años; 390 [57,7%] varones) incluidos en el análisis, 452 (67%) se sometieron a CO y 223 (33%) a SLC. En general, ninguno de los procedimientos tuvo un mayor riesgo de complicaciones mayores (89 [19,69%] frente a 35 [15,69%] P.207). Sin embargo, el CO tuvo un mayor riesgo de lesión de la vía biliar (18 [3,98] frente a 1 [0,44] p.009), hemorragia (media [DE] 165,43 ± 368,57 frente a 43,25 ± 123,42 p <0,001), lesión intestinal (20 [4,42%] frente a 0 [0,00] p.001 ) e infección de la herida (18 [3,98%] frente a 2 [0,89%] p.026), mientras que el SLC presentaba un mayor riesgo de fuga biliar (15 [3,31] frente a 16 [7,17] p.024). En el análisis multivariable, el índice de comorbilidad de Charlson (odds ratio [OR], 1,20; IC95%, 1,01-1,42), el uso de anticoagulantes (OR, 2,56; IC95%, 1,21-5,44), la clasificación de gravedad de la colecistitis grado III (OR, 2,96; IC95%, 1,48-5,94) y el ingreso de urgencia (OR, 6,07; IC95%, 1,33-27,74) se asociaron con la presentación de complicaciones mayores. Conclusiones: El SLC se asoció menos con complicaciones; sin embargo, hay escasa evidencia sobre sus resultados a largo plazo. Se necesitan más investigaciones sobre el SLC para establecer si es el más seguro a largo plazo como procedimiento de rescate.

Título traducido de la contribución	Colecistectomía laparoscópica subtotal frente a conversión a abierta como procedimiento de rescate: un estudio de cohortes
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	1-11
Número de páginas	11
Publicación	Surgical Endoscopy
DOI	https://doi.org/10.1007/s00464-024-10911-x
Estado	Publicada - jul. 9 2024

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@article{875a876c28f5416b978ea8b5fae28940,

title = "Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study",

abstract = "Background: The aim of this study is to evaluate morbidity and mortality in patients taken to conversion to open procedure (CO) and subtotal laparoscopic cholecystectomy (SLC) as bailout procedures when performing difficult laparoscopic cholecystectomy. Method: This observational cohort study retrospectively analyzed patients taken to SLC or CO as bailout surgery during difficult laparoscopic cholecystectomy between 2014 and 2022. Univariable and multivariable logistic regression models were used to identify prognostic factors for morbimortality. Results: A total of 675 patients were included. Of the 675 patients (mean [SD] age 63.85 ± 16.00 years; 390 [57.7%] male) included in the analysis, 452 (67%) underwent CO and 223 (33%) underwent SLC. Overall, neither procedure had an increased risk of major complications (89 [19.69%] vs 35 [15.69%] P.207). However, CO had an increased risk of bile duct injury (18 [3.98] vs 1 [0.44] P.009), bleeding (mean [SD] 165.43 ± 368.57 vs 43.25 ± 123.42 P <.001), intestinal injury (20 [4.42%] vs 0 [0.00] P.001), and wound infection (18 [3.98%] vs 2 [0.89%] P.026), while SLC had a higher risk of bile leak (15 [3.31] vs 16 [7.17] P.024). On the multivariable analysis, Charlson comorbidity index (odds ratio [OR], 1.20; CI95%, 1.01–1.42), use of anticoagulant agents (OR, 2.56; CI95%, 1.21–5.44), classification of severity of cholecystitis grade III (OR, 2.96; CI95%, 1.48–5.94), and emergency admission (OR, 6.07; CI95%, 1.33–27.74) were associated with presenting major complications. Conclusions: SLC was less associated with complications; however, there is scant evidence on its long-term outcomes. Further research is needed on SLC to establish if it is the safest in the long-term as a bailout procedure.",

author = "Camilo Ram{\'i}rez-Giraldo and Monroy, {Danny Conde} and Andr{\'e}s Isaza-Restrepo and Daniela Ayala and Juliana Gonz{\'a}lez-Tamayo and Vargas-Pati{\~n}o, {Ana Maria} and Luisa Trujillo-Guerrero and Isabella Van-Londo{\~n}o and Susana Rojas-L{\'o}pez",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = jul,

day = "9",

doi = "10.1007/s00464-024-10911-x",

language = "English (US)",

pages = "1--11",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

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TY - JOUR

T1 - Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure

T2 - a cohort study

AU - Ramírez-Giraldo, Camilo

AU - Monroy, Danny Conde

AU - Isaza-Restrepo, Andrés

AU - Ayala, Daniela

AU - González-Tamayo, Juliana

AU - Vargas-Patiño, Ana Maria

AU - Trujillo-Guerrero, Luisa

AU - Van-Londoño, Isabella

AU - Rojas-López, Susana

PY - 2024/7/9

Y1 - 2024/7/9

N2 - Background: The aim of this study is to evaluate morbidity and mortality in patients taken to conversion to open procedure (CO) and subtotal laparoscopic cholecystectomy (SLC) as bailout procedures when performing difficult laparoscopic cholecystectomy. Method: This observational cohort study retrospectively analyzed patients taken to SLC or CO as bailout surgery during difficult laparoscopic cholecystectomy between 2014 and 2022. Univariable and multivariable logistic regression models were used to identify prognostic factors for morbimortality. Results: A total of 675 patients were included. Of the 675 patients (mean [SD] age 63.85 ± 16.00 years; 390 [57.7%] male) included in the analysis, 452 (67%) underwent CO and 223 (33%) underwent SLC. Overall, neither procedure had an increased risk of major complications (89 [19.69%] vs 35 [15.69%] P.207). However, CO had an increased risk of bile duct injury (18 [3.98] vs 1 [0.44] P.009), bleeding (mean [SD] 165.43 ± 368.57 vs 43.25 ± 123.42 P <.001), intestinal injury (20 [4.42%] vs 0 [0.00] P.001), and wound infection (18 [3.98%] vs 2 [0.89%] P.026), while SLC had a higher risk of bile leak (15 [3.31] vs 16 [7.17] P.024). On the multivariable analysis, Charlson comorbidity index (odds ratio [OR], 1.20; CI95%, 1.01–1.42), use of anticoagulant agents (OR, 2.56; CI95%, 1.21–5.44), classification of severity of cholecystitis grade III (OR, 2.96; CI95%, 1.48–5.94), and emergency admission (OR, 6.07; CI95%, 1.33–27.74) were associated with presenting major complications. Conclusions: SLC was less associated with complications; however, there is scant evidence on its long-term outcomes. Further research is needed on SLC to establish if it is the safest in the long-term as a bailout procedure.

AB - Background: The aim of this study is to evaluate morbidity and mortality in patients taken to conversion to open procedure (CO) and subtotal laparoscopic cholecystectomy (SLC) as bailout procedures when performing difficult laparoscopic cholecystectomy. Method: This observational cohort study retrospectively analyzed patients taken to SLC or CO as bailout surgery during difficult laparoscopic cholecystectomy between 2014 and 2022. Univariable and multivariable logistic regression models were used to identify prognostic factors for morbimortality. Results: A total of 675 patients were included. Of the 675 patients (mean [SD] age 63.85 ± 16.00 years; 390 [57.7%] male) included in the analysis, 452 (67%) underwent CO and 223 (33%) underwent SLC. Overall, neither procedure had an increased risk of major complications (89 [19.69%] vs 35 [15.69%] P.207). However, CO had an increased risk of bile duct injury (18 [3.98] vs 1 [0.44] P.009), bleeding (mean [SD] 165.43 ± 368.57 vs 43.25 ± 123.42 P <.001), intestinal injury (20 [4.42%] vs 0 [0.00] P.001), and wound infection (18 [3.98%] vs 2 [0.89%] P.026), while SLC had a higher risk of bile leak (15 [3.31] vs 16 [7.17] P.024). On the multivariable analysis, Charlson comorbidity index (odds ratio [OR], 1.20; CI95%, 1.01–1.42), use of anticoagulant agents (OR, 2.56; CI95%, 1.21–5.44), classification of severity of cholecystitis grade III (OR, 2.96; CI95%, 1.48–5.94), and emergency admission (OR, 6.07; CI95%, 1.33–27.74) were associated with presenting major complications. Conclusions: SLC was less associated with complications; however, there is scant evidence on its long-term outcomes. Further research is needed on SLC to establish if it is the safest in the long-term as a bailout procedure.

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U2 - 10.1007/s00464-024-10911-x

DO - 10.1007/s00464-024-10911-x

M3 - Research Article

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SN - 0930-2794

SP - 1

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JO - Surgical Endoscopy

JF - Surgical Endoscopy

ER -

Subtotal laparoscopic cholecystectomy versus conversion to open as a bailout procedure: a cohort study

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