Suture Versus Non-Suture Closure of the Cystic Duct Orifice During Fenestrating Laparoscopic Subtotal...

Background/Objectives: Laparoscopic subtotal cholecystectomy (LSC) can be performed using either the fenestrating or reconstituting method. In the fenestrating method, some surgeons additionally perform suture closure of the cystic duct orifice, whereas others do not. However, evidence regarding the clinical significance of suture closure remains limited. Methods: Between April 2018 and December 2023, 934 patients underwent cholecystectomy at our institution. Among them, 37 underwent LSC because standard cystic duct control could not be achieved intraoperatively. Of these, 34 were treated with the fenestrating method. Among these 34 patients, 27 did not undergo suture closure of the cystic duct orifice (non-suture group), while 7 underwent suture closure (suture group). Perioperative outcomes were retrospectively compared between the groups. Results: No statistically significant differences were observed between the groups in operative time, drain retention period, postoperative hospital stay, postoperative bile leakage, or the need for postoperative endoscopic treatment. Similar findings were observed in exploratory subgroup analyses among patients with intraoperative bile flow from the cystic duct orifice (IBF) and within the non-suture group according to the presence or absence of IBF. No reoperations, readmissions, or deaths occurred in either group. However, postoperative bile leakage (11/27 [40.7%] vs. 1/7 [14.3%]) and endoscopic treatment (7/27 [25.9%] vs. 1/7 [14.3%]) were more frequent in the non-suture group, although not statistically significant. Conclusions: In this small retrospective single-institution cohort, no statistically significant differences in perioperative outcomes were observed between patients with or without suture closure of the cystic duct orifice during fenestrating LSC. However, the non-suture group showed a trend toward higher rates of postoperative bile leakage and endoscopic treatment. These hypothesis-generating findings should be interpreted cautiously.