Cystic Duct Closure Lowers Risk for Postoperative Bile Leaks

TOPLINE:

Fenestrating and reconstituting techniques for subtotal cholecystectomy show no significant difference in long-term outcomes. Cystic duct closure in fenestrating procedures reduced postoperative bile leaks by more than four times.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 218 patients who underwent subtotal cholecystectomy between 2010 and 2020 in one health system.
• Patients were categorized into fenestrating (n = 113) and reconstituting (n = 105) subtypes on the basis of keywords from operative reports.
• Demographic and clinical information were gathered manually, while patient-reported outcomes were collected by phone using an abbreviated Gastrointestinal Quality of Life Index.
• Postoperative complications and interventions were reviewed at 30 and 90 days. Long-term outcomes were tracked over a median follow-up of 63 months.
• Patients were excluded if they had a cholecystectomy as part of a larger surgery or had cancer of the liver, pancreas, gallbladder, or bile duct.

TAKEAWAY:

• No significant differences were found in postoperative outcomes between fenestrating and reconstituting partial cholecystectomies, including rates of bile duct injury, bile leak, and readmission.
• Cystic duct closure during fenestrating cholecystectomy significantly reduced the likelihood of postoperative bile leak (6.0% vs 24.1%; P = .012).
• The laparoscopic technique was associated with fewer postoperative bile leaks (2.9% vs 16.8%; P = .001) and wound complications (4.8% vs 13.3%; P = .035) compared with open operations.
• Long-term patient-reported outcomes indicated that 92.2% of patients did not experience recurrent biliary pain or postprandial nausea/vomiting, but 37.2% reported dietary restrictions.

IN PRACTICE:

“Given no notable difference in postoperative or quality-of-life outcomes between subtotal cholecystectomy subtypes, consideration of technique depends on intraoperative conditions,” wrote the authors of the study.

SOURCE:

The study was led by Abby Gross, MD, of the Cleveland Clinic Foundation in Cleveland, and was published online in Surgery.

LIMITATIONS:

The retrospective nature of the study may have introduced selection bias. The severity of cholecystitis was also retrospective and assigned based on operative reports, which may have led to misclassification. The manual review of operative reports relied on the surgeon descriptions, which may lack detail. Patient-reported outcomes may include information bias.

DISCLOSURES:

The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.