Table 1.
Summary of the univariable analysis to detect risk factors for bile leak associated with subtotal cholecystectomy
| Variable | Bile leak (%) | No bile leak (%) | Odds ratio (95% CI) | P-value |
|---|---|---|---|---|
| Number of patients | 28 | 53 | – | – |
| Preoperative factors | ||||
| Age | ||||
| Median (IQR) | 58 (25.25) | 55 (23) | – | – |
| ≥ 60 years | 14 (50.0) | 24 (45.3) | 1.208 (0.4988–2.941) | 0.8155 |
| Sex | ||||
| Female | 17 (60.7) | 39 (73.6) | 0.5548 (0.2046–1.554) | 0.3123 |
| Male | 11 (39.3) | 14 (26.4) | 1.803 (0.6434–4.887) | |
| BMI, median (IQR) | 30.7 (6.5) | 29.8 (7.8) | – | – |
| BMI, by category | ||||
| < 25 kg/m2 | 4 (14.3) | 7 (13.2) | 1.095 (0.3319–4.069) | > 0.9999 |
| ≥ 25–29.9 kg/m2 | 6 (21.4) | 20 (37.7) | 0.4500 (0.1529–1.278) | 0.2104 |
| ≥ 30–39.9 kg/m2 | 16 (57.1) | 19 (35.8) | 2.386 (0.9778–6.247) | 0.0983 |
| ≥ 40 kg/m2 | 2 (7.1) | 7 (13.2) | 0.5055 (0.1010–2.659) | 0.4865 |
| Comorbidities excluding obesity | 20 (71.4) | 29 (54.7) | 2.069 (0.8106–5.664) | 0.1604 |
| Past surgical history | ||||
| Midline laparotomy | 0 | 2 (3.8) | 0.000 (0.000–4.092) | 0.5420 |
| Laparoscopic RYGB | 1 (3.6) | 0 | + ∞ (0.2103 to + ∞) | 0.3457 |
| Previous hospitalisation for gallstone disease | 19 (67.9) | 37 (69.8) | 0.9129 (0.3417–2.382) | > 0.9999 |
| Duration of acute symptoms before admission, median (IQR) | 6.5 (5) | 6 (5) | – | – |
| Common bile duct dilatation (≥ 7 mm) | 12 (42.9%) | 14 (26.4) | 2.089 (0.7745–5.641) | 0.1431 |
| WBC count per mm3, median (IQR) | 9 (9.1) | 8.9 (5.7) | – | – |
| CRP per mg/L, median (IQR) | 230 (280) | 121 (260) | – | – |
| Preoperative diagnosis of acute cholecystitis | 18 (64.3) | 28 (52.8) | 1.607 (0.6594–3.930) | 0.3549 |
| Acute cholecystitis, by Tokyo classification | ||||
| Grade 1 | 3 (10.7) | 8 (15.1) | 0.6750 (0.1815–2.595) | 0.7397 |
| Grade 2 | 7 (25.0) | 15 (28.3) | 0.8444 (0.3245–2.446) | 0.7991 |
| Grade 3 | 8 (28.6) | 5 (9.4) | 3.657 (1.166–11.27) | 0.0546 |
| ASA, by class | ||||
| I | 4 (14.3) | 8 (15.1) | 0.9375 (0.2902–3.164) | > 0.9999 |
| II | 22 (78.6) | 40 (75.5) | 1.192 (0.4299–3.723) | > 0.9999 |
| III | 1 (3.6) | 5 (9.4) | 0.3556 (0.02921–2.923) | 0.6589 |
| IV | 1 (3.6) | 0 | + ∞ (0.2103 to + ∞) | 0.3457 |
| Emergent/urgent STC | 18 (64.3) | 28 (52.8) | 1.607 (0.6594–3.930) | 0.3549 |
| Intraoperative factors | ||||
| Surgical approach | ||||
| Laparoscopic | 27 (96.4) | 52 (98.1) | 0.5192 (0.02688–10.20) | > 0.9999 |
| Conversion to open | 1 (3.6) | 1 (1.9) | 1.926 (0.09801–37.20) | > 0.9999 |
| Main surgical finding | ||||
| Acute cholecystitis | 22 (78.6) | 28 (52.8) | 3.274 (1.182–9.503) | 0.0308 |
| Mild | 1 (3.6) | 0 | + ∞ (0.2103 to + ∞) | 0.3457 |
| Severe | 21 (75.0) | 28 (52.8) | 2.679 (1.015–6.773) | 0.0601 |
| Suppurative | 9 (32.1) | 14 (26.4) | 1.320 (0.4946–3.681) | 0.6121 |
| Gangrenous | 6 (21.4) | 10 (18.9) | 1.173 (0.3556–3.634) | 0.7770 |
| Perforated | 6 (21.4) | 4 (7.5) | 3.341 (0.9209–11.15) | 0.0864 |
| Chronic cholecystitis | 6 (21.4) | 25 (47.2) | 0.3055 (0.1052–0.8461) | 0.0308 |
| STC, by variant | ||||
| STC-1 (A, B and C) | 16 (57.1) | 45 (84.9) | 0.2370 (0.0872–0.6641) | 0.0132 |
| STC-1A | 6 (21.4) | 28 (52.8) | 0.2435 (0.0839–0.6727) | 0.0089 |
| STC-1B | 9 (32.1) | 14 (26.4) | 1.320 (0.4946–3.681) | 0.6121 |
| STC-1C | 1 (3.6) | 3 (5.7) | 0.6173 (0.0460–4.334) | > 0.9999 |
| STC-2 (A and B) | 11 (39.3) | 8 (15.1) | 3.640 (1.313–9.991) | 0.0257 |
| STC-2A | 11 (39.3) | 5 (9.4) | 6.212 (1.898–18.25) | 0.0026 |
| STC-2B | 0 | 3 (5.7) | 0.000 (0.000–2.166) | 0.5478 |
| STC-3 | 1 (3.6) | 0 | + ∞ (0.2103 to + ∞) | 0.3457 |
| STC, by intervention to hepatic wall | ||||
| Removal of hepatic wall | 16 (57.1) | 45 (84.9) | 0.2370 (0.0872–0.6641) | 0.0132 |
| Non-removal of hepatic wall | 12 (42.9) | 8 (15.1) | 4.219 (1.506–11.46) | |
| STC, by type of completion | ||||
| Open-tract STC | 22 (78.6) | 16 (30.2) | 8.479 (2.941–25.68) | < 0.0001 |
| Closed-tract STC | 6 (21.4) | 37 (69.8) | 0.1179 (0.0389–0.3401) | |
| Method of closing the biliary tract | ||||
| Endoloop ligature | 4 (14.3) | 31 (58.5) | 0.1183 (0.0408–0.3866) | 0.0001 |
| Continuous suture | 2 (7.1) | 3 (5.7) | 1.282 (0.2163–6.578) | > 0.9999 |
| Endo GIA stapler | 0 | 1 (1.9) | 0.000 (0.000–17.04) | > 0.9999 |
| Hem-o-lock system | 0 | 2 (3.8) | 0.000 (0.000–4.092) | 0.5420 |
OR, odds ratio; CI, confidence interval; ICR, interquartile range; SD, standard deviation; BMI, body mass index; RYGB, Roux-en-Y gastric bypass; STC, subtotal cholecystectomy; WBC, white blood cell; ASA, American Society of Anaesthesiologists; ∞, infinity; GIA, gastrointestinal anastomosis