Subtotal cholecystectomy as a bailout strategy in difficult cholecystectomy: Outcomes and patient selection criteria
İbrahim Halil Öcal1, Sinan Hatipoğlu1
1Department of General Surgery, Adıyaman Training and Research Hospital, Adıyaman, Turkey.
Backgrounds/Aims:
Subtotal cholecystectomy is a salvage procedure when critical safety margins cannot be achieved in difficult cases. This study evaluated the impact of surgical approach and technique on short- and long-term outcomes.
Methods:
A retrospective review of 101 patients who underwent subtotal cholecystectomy between January 2010 and November 2024 was conducted. Patients were grouped by approach: laparoscopic (n = 42), open (n = 31), and conversion (n = 28). Techniques were classified as fenestrating or reconstituting. Complications were assessed using the Clavien-Dindo classification. Logistic regression identified risk factors, and Cox regression evaluated long-term outcomes. Intention-to-treat analysis was performed.
Results:
The mean follow-up was 6.7 years. Morbidity was lower in the laparoscopic group (9.5%) than in the open group (45.2%) (p < 0.001). However, after adjustment for age, American Society of Anesthesiologists score, and emergency status, surgical approach was not an independent risk factor (adjusted odds ratio 1.54, p = 0.214). No significant differences were observed between fenestrating and reconstituting techniques. Five-year complication-free survival was 92.9% in the laparoscopic group and 74.2% in the open group (p = 0.018). No stone recurrence was observed.
Conclusions:
Subtotal cholecystectomy is a safe option in complex cases. Outcome differences are likely related to patient selection rather than technique. Technique selection should be based on intraoperative findings.
