Subtotal cholecystectomy: is it a safe option for difficult gall bladders?

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Safety and Outcomes
• Minimally Invasive Surgery

Background:

• Subtotal cholecystectomy (STC) serves as an alternative to total cholecystectomy (TC) when severe inflammation or adhesions complicate the hepatocystic triangle.
• Evaluating the safety profile of STC is crucial for guiding surgical decision-making in challenging gallbladder removal scenarios.

Purpose of the Study:

• To assess the safety and complication profile of subtotal cholecystectomy (STC).
• To compare outcomes between different types of STC and identify risk factors for complications.

Main Methods:

• Retrospective review of 97 patients undergoing STC between February 2009 and August 2019.
• Classification of STC into reconstituting (R-STC) and fenestrating (F-STC) types.
• Exclusion of cases involving gallbladder malignancy or concurrent operations.

Main Results:

• STC was performed in 1.7% of 5,664 cholecystectomies, with a high conversion rate (48.8%) and overall complication rate (45.4%).
• Postoperative bile leak occurred in 19.6% of patients, significantly higher in acute settings (41%) versus elective (13%).
• No iatrogenic bile duct injuries were reported; 90-day readmission was 8.2%, with no in-hospital mortalities.

Conclusions:

• STC is effective in preventing bile duct injury during difficult cholecystectomies.
• The perioperative morbidity associated with STC is considerable, necessitating surgeon awareness and risk mitigation strategies.