Page 13 - JCTR-10-1

Journal of Clinical and Translational Research 2024; 10(1): 9-17

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Subtotal cholecystectomy as an approach to preventing injury in the

left-sided gallbladder in the emergency surgery setting: A case study

Raimundas Lunevicius *, Mohamed Zafar Chawdhery , Julie Jones 1
1
2
1 Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom,
2 St. Anthony’s Hospital, Surrey SM3 9DW, United Kingdom

ARTICLE INFO ABSTRACT

Article history: A left-sided gallbladder is an unusual anatomic variation that makes gallbladder surgery challenging.
Received: November 04, 2023 Two systematic reviews on surgery for left-sided gallbladder highlighted high iatrogenic bile duct
Accepted: December 05, 2023 injury rates of 4.4% and 7.3%. This paper reports a female in her 40s with symptoms of acute calculous
Published online: February 1, 2024 cholecystitis admitted to a secondary health-care center. After inserting four ports through standard
sites for conventional gallbladder surgery, laparoscopic inspection revealed a phlegmonous left-sided
Keywords gallbladder. No discordant situs of abdominal viscera was noted. Laparoscopic surgery was converted
Left-sided gallbladder to open subtotal closed-tract cholecystectomy. No post-operative complications related to the surgical
Acute cholecystitis site were observed. A left-sided gallbladder affected by severe inflammation and infection is an
Subtotal cholecystectomy extraordinary condition that should be considered as a risk factor. If an inflamed left-sided gallbladder
Partial cholecystectomy is encountered, emergency subtotal cholecystectomy is an alternative to total cholecystectomy when
Case report the circumstances to adopt the strategies of a culture of safety in cholecystectomy for complete
removal of the gallbladder are unfavorable.
*Corresponding author: Relevance for Patients: Subtotal cholecystectomy in patients with left-sided gallbladder reduces the
Raimundas Lunevicius risk for bile duct injuries, outweighing the potential side effects stemming from this surgical approach.
Department of General Surgery, Liverpool
University Hospitals NHS Foundation
Trust, Lower Lane, Liverpool, L9 7AL,
United Kingdom. 1. Introduction
Email: raimundas.lunevicius@liverpoolft.nhs.uk
Anatomical variants within the biliary ductal system are common [1,2]; contrarily,
© 2024 Author(s). This is an Open-Access aberrations are rare. The true left-sided gallbladder is one of them, with an estimated
article distributed under the terms of the incidence rate of <0.3% [3,4].
Creative Commons Attribution-Noncommercial A recent systematic review summarized 53 case reports and case series on managing the
License, permitting all non-commercial use,
distribution, and reproduction in any medium, left-sided gallbladder [5]. Briefly, cholecystectomy for symptomatic gallstones was performed
provided the original work is properly cited. in 90 (80.4%) of 112 total patients. A major iatrogenic injury to the common duct requiring
hepaticojejunostomy occurred in four patients (4.4%). Another review paper revealed a higher
bile duct injury rate (7.3%) in 55 patients during left-sided cholecystectomy [6].
Despite the high rates of bile duct injury in this subpopulation of patients, a left-sided
gallbladder has not yet been elucidated as a surgical factor requiring pre-operative and (or)
intraoperative consideration in applying the gallbladder bailout surgery principle, which
is always directed at iatrogenic injury prevention [7-9]. This is especially important in an
emergency general surgery setting. In this paper, we aim to describe an incidental surgical
finding from a clinical case of an urgent subtotal cholecystectomy for a left-sided gallbladder.
Insufficient awareness of the potential dangers associated with this anatomical variation of
the gallbladder can expose a patient to a substantially higher risk of having life-changing
consequences related to biliary or vascular injuries.
DOI: https://doi.org/10.36922/jctr.00128