Técnicas de colecistectomía laparoscópica subtotal como estrategias de manejo en colecistectomías difíciles

Abstract

Introduction: Laparoscopic cholecystectomy is one of the most frequent surgical procedures for symptomatic biliary pathology, with or without complications. There are determinants for identifying a difficult cholecystectomy, such as lack of surgeon's experience or clinical conditions that lead to variations in the biliary vascular anatomy, limiting the dissection of the hepatocystic triangle and preventing critical safety vision, leading to a higher risk of iatrogenic injuries and a greater rate of complications. Conventional cholecystectomy continues to be the Gold Standard in difficult cases. Therefore, consideration arises to opt for alternative surgical techniques among which laparoscopic subtotal cholecystectomy is found, which has gained relevance as a managem ent strategy in challenging gallbladder cases. Objective: To analyze laparoscopic subtotal cholecystectomy techniques as management strategies in difficult cholecystectomies through the review of existing scientific evidence. Materials and Methods: The theoretical foundation of this descriptive study is obtained through the analysis of literature from biomedical databases with the proper selection and extraction of relevant data for this review. Conclusions: Subtotal cholecystectomy has been proposed as a management strategy in challenging cases where total cholecystectomy is complicated by anatomical factors, severe inflammation, adhesions, or other complications. Subtotal cholecystectomy techniques, including fenestrated and reconstructive approaches, have become viable options as rescue strategies. However, their outcomes rely on the surgeon's experience, their selective use, and the risk-benefit consideration for each patient.