PROSPECTIVE EVALUATION OF SURGICAL TECHNIQUES FOR SUBTOTAL CHOLECYSTECTOMY IN PATIENTS WITH ACUTE CHOLECYSTITIS: AN EAST MULTICENTER STUDY

Background: Different techniques have been described for performance of subtotal cholecystectomy, namely fenestrating and reconstituting subtypes. Currently, little remains known about the impact of these different techniques on short-term and long-term patient outcomes. The aim of this study is to compare various clinical outcomes between patients undergoing fenestrated and reconstituting subtotal cholecystectomy for acute cholecystitis.
Methods: This is a multicenter prospective observational study sponsored by the EAST Multicenter Trials Committee. Between July 2019 and June 2022, we included patients (age ≥18 years) who received surgical management of acute cholecystitis defined by the Tokyo Guideline 18 diagnostic criteria. In-hospital and long-term (6-month) outcomes for patients undergoing fenestrating versus reconstituting subtotal cholecystectomy were compared.
Results: A total of 2,685 patients with acute cholecystitis were enrolled from 9 centers. The median age was 41 years (IQR: 30-53) and 28% were male. Diabetes mellitus was the most common comorbid condition (12%). Of those, 162 patients (6.1%) underwent subtotal cholecystectomy (laparoscopic: 128 (79%), laparoscopic converted to open: 30, open: 4), whereas laparoscopic converted to open total cholecystectomy was performed in 41 patients (1.6%). Approximately 78% of subtotal cholecystectomy used fenestrating technique rather than reconstituting technique (Table 1). In the early postoperative period, patients in the fenestrating group more commonly developed bile leaks (32% versus 8.6%, p=0.005) and required readmission within 30 days (30/125: 24% versus 2/35: 5.7%, p=0.016). There were not significant differences in the rate of secondary interventions (34% versus 17%, p=0.063). At 6-month follow-up, the incidence of recurrent biliary disease was statistically similar between the fenestrating and reconstituting groups (11% versus 21%, p=0.158). Only 5 patients (4.3%) underwent completion cholecystectomy during the follow-up period.
Conclusions: In this multicenter study, subtotal cholecystectomy was more commonly performed than open conversion total cholecystectomy as a bail-out procedure for acute cholecystitis. Both fenestrating and reconstituting subtypes were associated with recurrent biliary disease and complications requiring secondary intervention and readmission in the early and later postoperative period.