OGBN P07 Fenestrating vs Reconstituting - Outcomes following 170 subtotal cholecystectomies

Abstract Background Laparoscopic subtotal cholecystectomy (LSC) is a recognised option when the “critical view” cannot be safely delineated. It carries high morbidity rate with increased frequencies of bile leak occurring however reducing risk duct injury. LSC can classified into fenestrating or reconstituting and surgical practice varies as considered to more complex. Our aim study was look at respect techniques used, complications overall outcomes. Methods All adult patients undergoing between January 2015 – December 2021 were retrospectively identified on our electronic database. Data gathered included: Patient demographics, previous acute biliary presentations, operative details/technique, length stay (LOS), 30-complications, 30-day mortality, readmissions follow up investigations/procedures. Descriptive statistics, Chi squared, relative used analyse results. Results 170 underwent in period increasing most years. Median age 67 86:84 Female Male ratio. Rates varied drastically different surgeons from 0.1% 19% compared total number laparoscopic cholecystectomies. 130 (76%) performed setting 63/170 (37%) had presentations. LOS 5 days. Most Fenistrating (155 [67.6%] vs. 55 [32.3%]). 80 (47%) complications. These graded by Clavin-dindo grade: I 3 (3.7%); II 34 (42.5%); IIIa 26 (32.5%); IIIb 16 (20%) IV 1 (1.25%). The frequent complication leak; 60 (35.2%) followed collection 8 (4.7%). Other notable pancreatitis; (1.7%), AKI; 2 (1%), injury; (0.5%) duodenal (0.5%). (9.4%) returns theatre, 14 (8.2%) 35 (20.5%) multiple attendances day unit following discharge. Further analysis demonstrated that fenestrated technique associated greater (p<0.01 RR 2.1 [95% C.I. 1.3–6.3]) post ERCP 3.8 1.6–14]). (1.1%) required completion cholecystectomy, one form each technique. Conclusions We present largest single datasets LSC, 2nd UK population. increasing, likely safe alternative open conversion, large surgeon variability. majority are have has morbidity, both reoperation/reintervention rate, readmission accompanied follow-up requirement. Despite being favoured we shown it poorer data would suggest if then reconstituted should possible.