SECURITY OF SUBTOTAL LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS IN THE SOUTHEASTERN MEXICO
Alfonso Gerardo Pérez-Morales*, Margarita Jiménez-Paxtian, Arturo Triana-Romero, Fernando Diaz-Roesch, Jose M. Remes Troche, Alejandro Fonseca-Pouchoulen, Mercedes Amieva-Balmori, Karla Rocío García-Zermeño, Federico B. Roesch Dietlen
Fisiologia Digestiva, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
Background: Subtotal cholecystectomy has been used in cases of technically difficult cholecystectomy in order to avoid injury of the main the bile duct. In Mexico there are few reports, there for we consider it is important to present the experience of a surgical groupAim: To determine the security of subtotal laparoscopic cholecystectomy in patients with acute cholecystitis.Material and methods: We performed a retrospective observational comparative study in patients with acute cholecystitis that underwent to laparoscopic cholecystectomy in private hospitals of the city of Veracruz, Mexico during a period of 18 years. Variables analyzed: Anthropometric characteristics, comorbidities, conversion to a conventional surgery, duration of the surgery, hospital stay, morbidity and mortality. Statistical analysis: central mediated and dispersion and standard deviation were applied, by descriptive statistics applying the program IBM.SPSSv22. Results: We reviewed 1,101 cases of patients with vesicular lithiasis who underwent to cholecystectomy, with average age 49 ± 15.68 years, with predominance of the female gender 75.67% and BMI 29.31 ± 2 without statistically significant difference between both groups. 223 of them presented acute cholecystitis (20.25%), which were divided into 2 groups: A) Total cholecystectomy 82.95% and B) Subtotal cholecystectomy 17.05%. The risk factors were present at 37.43% of the population, with predominance of obesity in about 50% of them, followed by hypertension, diabetes mellitus and ischemic heart disease. The surgical time in group A was 63.36 ± 12.14 minutes, while in group B it doubled to 139.52 ± 32.91 (p = 0.001), the conversion rate was 1.62 and 2.63% and the average days / stay was 1.81 ± 3.80 and 3.80 ± 12.86 respectively for each group. The rate of complications in group A was 5.56% and in group B it was 21.34%, of which they were severe in 3.24% of group A and 7.89% of group B, subhepatic abscess, biliary leak and pathway lesion. The injury of the main bile duct event occurred in the group undergoing total cholecystectomy, with no statistically significant difference between the two groups, there was no mortality in the first group and 1 patient died in the second group (rate of 2.63%) (Table 1). Conclusions:Subtotal cholecystectomy is a valuable resource in patients with acute cholecystitis, in our series it was a secure and reliable procedure to avoid injury to the bile duct.
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