Factores de riesgo de fuga biliar en los pacientes sometidos a colecistectomía subtotal como procedimiento de rescate ante una colecistectomía difícil: Una cohorte retrospectiva

Introduction. Subtotal cholecystectomy is a rescue procedure for difficult cholecystectomy, whose use is increasing. The most common complication of subtotal cholecystectomy is bile leak. This complication increases intra-abdominal collections, electrolyte disorders. hospital stay, and the need for postoperative endoscopic retrograde cholangiopancreatography (ERCP). Methods. A retrspective cohort study was conducted to follow up on patients who underwent subtotal cholecystectomy between 2014 and 2022. A logistic regression model was used to identify risk factors for postoperative bile leak. Results. 395 patients were included. The majority of subtotal cholecystomies were laparoscopic and reconstructive. The frequency of bile leak was 13.4%. An association was found with leukocyte count (p=0.014) and gallbladder wall thickness (p=0.042). Patients with postoperative bile leak had a prolonged hospital stay (p=0.001), a greater requirement for postoperative ERCP to manage choledocholithiasis (p=0.007) or bile leak (p<0.001), a higher risk of reintervention (p<0.001), and major complications (p< 0.001). Conclusion. Having strategies to establish the risk of postoperative bile leak is essential, as it could allow for early or preventive intervention. However, few studies have investigated the risk factors for bile leak. Our study identified that white blood cell count and gallbladder wall thickness are associated with increased risk of bile leak.