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Published on: November 25, 2025
Completion cholecystectomy: a meta-analysis of indications, techniques and outcomes
Nicolas J Smith1, Simon D Lai1, John A Windsor1
1Department of Surgery, University of Auckland, Auckland, New Zealand.
Background:
Completion cholecystectomy (CC) after subtotal cholecystectomy is being performed more often and can be a surgically challenging. This meta-analysis aimed to evaluate indications, techniques, and outcomes of CC.
Methods:
A PRISMA-compliant systematic review of PubMed, MEDLINE, Embase, and CENTRAL (1995-2025). Random-effects models generated pooled estimates for the analysed outcomes.
Results:
Forty-eight studies were identified (1225 patients). Common indications for CC were symptomatic cholelithiasis (55.8 %, 95 % CI: 45.6-70.8 %) and acute cholecystitis (19.8 %, 10.4-34.4 %). The interval from initial surgery to CC was 47 months (95 % CI: 36-58). Laparoscopy was the most frequent approach (75.6 %), with the open approach in 15.6 %. Symptom resolution was achieved in 92.5 % (95 % CI: 87.5-95.6 %) across a mean follow-up period of 595 days (95 % CI: 429-761). Overall complication rate was 14.0 % (95 % CI: 11.3-17.2 %). The rate of bile duct injury (BDI) was 2.0 % (95 % CI: 1.1-3.6 %). Sensitivity and subgroup analyses found no significant differences from the primary results.
Conclusion:
Completion cholecystectomy is often feasible laparoscopically and is highly effective in relieving symptoms. The risk of complications and BDI remains high, and further research should focus on how to reduce the morbidity associated with CC.
