Gastrointestinal Endoscopy Monthly Podcasts
Sep 14, 2026 · 32 min · 9 segments
GIE Editor-in-Chief Dr Douglas G. Adler chats with Dr Thomas Tielleman about his article in the September issue: "Evaluating the impact of different biliary stents for bile leak after fenestrated…
Douglas AdlerHost
Thomas TiellemanGuest
Um, so, so you're talking about, right, how best to treat the so-called fenestrated cholecystectomy.
And why don't you define fenestrated cholecystectomy for listeners who may not be familiar with that term?
Yeah, so, um, basically there's, when the surgeons run into, um, a really challenging anatomy or they can't get the visualization that they want, um, they do have the option of doing a subtotal cholecystectomy, and there's two different kinds.
There's reconstituting, where, um, they'll leave part of the gallbladder and close it off with sutures or clips, and then there's fenestrated, where, um, they leave behind part of the gallbladder, but they leave that area open.
Um, so, um, with fenestrated you can imagine the- there's a big opening in the gallbladder by nature, incredibly high propensity to have a bile leak afterwards.
So that was kind of the point of looking at this study, um, what to do in that specific type of bile leak.
We're recording this on Sunday, and the last ERCP I did last week before the week ended was a fenestrated-
It, it's interesting because, you tell me if you agree or not, but I feel like something has changed in the minds of our general surgeons.
And I feel like the number of fenestrated cholecystectomies, or partials or subtotals, whatever you wanna call them, they're all versions of the same thing, has skyrocketed.
And, you know, I wonder, like, I didn't go to SAGES last year or the year before.
I feel like their threshold to do these partials is very, very low, whereas just a few years ago they would hang in there and they would come out and say, "Oh, that was a really, really, really tough chole, but we got it." Whereas now I feel like I'm hearing very frequently from my surgeons, "Yeah, that was a tough one.
But, um, I do feel like, as I've talked to other colleagues, it went from, "What is that, huh?" Of to, "Oh, yeah.
I see that from time to time," or, "It's picking up," or, "Our center has a lot of these now," which is not something I used to run into.
Um, so, so you're talking about, right, how best to treat the so-called fenestrated cholecystectomy.
And why don't you define fenestrated cholecystectomy for listeners who may not be familiar with that term?
Yeah, so, um, basically there's, when the surgeons run into, um, a really challenging anatomy or they can't get the visualization that they want, um, they do have the option of doing a subtotal cholecystectomy, and there's two different kinds.
There's reconstituting, where, um, they'll leave part of the gallbladder and close it off with sutures or clips, and then there's fenestrated, where, um, they leave behind part of the gallbladder, but they leave that area open.
Um, so, um, with fenestrated you can imagine the- there's a big opening in the gallbladder by nature, incredibly high propensity to have a bile leak afterwards.
So that was kind of the point of looking at this study, um, what to do in that specific type of bile leak.
We're recording this on Sunday, and the last ERCP I did last week before the week ended was a fenestrated-
It, it's interesting because, you tell me if you agree or not, but I feel like something has changed in the minds of our general surgeons.
And I feel like the number of fenestrated cholecystectomies, or partials or subtotals, whatever you wanna call them, they're all versions of the same thing, has skyrocketed.
And, you know, I wonder, like, I didn't go to SAGES last year or the year before.
I feel like their threshold to do these partials is very, very low, whereas just a few years ago they would hang in there and they would come out and say, "Oh, that was a really, really, really tough chole, but we got it." Whereas now I feel like I'm hearing very frequently from my surgeons, "Yeah, that was a tough one.
But, um, I do feel like, as I've talked to other colleagues, it went from, "What is that, huh?" Of to, "Oh, yeah.
I see that from time to time," or, "It's picking up," or, "Our center has a lot of these now," which is not something I used to run into.
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