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2025, Number 3

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Rev Med UAS 2025; 15 (3)

Fenestrated subtotal cholecystectomy, a viable and safe option for complicated acute cholecystitis: a case series

Fernandez-Báez RY, Almeida-Rodriguez DF, Cota-Valdez YD

Language: Spanish
References: 26
Page: 164-173
PDF size: 191.91 Kb.


ABSTRACT

Objective: To demonstrate the role of laparoscopic fenestrated subtotal cholecystectomy (LSSC) as an alternative for complex cases, where the exacerbation presents anatomical distortion. Methods: This was a descriptive, observational case series study that included patients with severe acute cholecystitis (Parkland grade IV-V, Tokyo grade II) who underwent LSSC between June and September 2024. Results: Six patients (four women; two men) with a median age of 52 years were included. The median time to onset was 8 days, with ultrasound-confirmed pyocholecystitis in all cases. The average surgical time was 50 minutes, with a median blood loss of 8 ml. 70-80% of the gallbladder wall was resected, with no conversions to open surgery. The postoperative hospital stay was 1.6 days, with one postoperative complication (16.7%) due to pain. The Penrose drain remained in place for a median of 30 days. There were no cases of biliary leak, reoperation, infectious complications, or mortality. Conclusions: LSSC represents a safe and effective alternative for severe acute cholecystitis, allowing the procedure to be completed laparoscopically without conversions. An early decision to perform LSSC in complex cases could reduce postoperative complications.


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