Outcomes of subtotal cholecystectomy from a large tertiary New Zealand hospital

Subtotal cholecystectomy (StC) is a recognised bail-out strategy for difficult cholecystectomy. The aim of the study was to analyse technical aspects and outcomes associated with subtypes of StC.

All perioperative data of patients who underwent StC at Christchurch Hospital between June 2015 to September 2023 were retrospectively identified and analysed. The subtypes were classified as reconstituting (rStC), fenestrating (fStC), and remnant posterior wall (pwStC) subtotal cholecystectomy.

Of the 6251 patients who underwent cholecystectomy, 422 (6.8 %) underwent StC, and 132 (31.3 %), 115 (27.3 %), 175 (41.5 %) underwent rStC, fStC and pwStC respectively.pwStC was generally associated with superior, and fStC inferior outcomes. In patients who had fStC, rStC and pwStC; 38 (33.0 %), 12 (9.1 %), 6 (3.4 %) developed bile leak (p < 0.001), 20 (17.4 %), 12 (9.1 %), 3 (1.7 %) developed intraabdominal collections (p < 0.001), and 28 (24.3 %), 10 (7.6 %) and 9 (5.1 %) required post-operative ERCP (p < 0.001), respectively. No difference in rates of delayed post-op biliary events including cholecystitis and choledocholithiasis were noted across the subgroups (p = 0.775).

There are technical variations of StC with different complication profiles. Surgeons should be aware of these nuances, as it may help inform decision making when faced with need to perform StC.