Related Experiment Video
Updated: Jul 10, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Cystic duct management in subtotal cholecystectomy: is closure necessary?
Kenichi Ishibayashi1, Kaichiro Kato1, Satoshi Takada1
1Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, Japan.
Insights
Subtotal cholecystectomy (SC) outcomes were compared with and without closure of the cystic duct orifice or remnant gallbladder. While complications were similar, non-closure was associated with longer hospital stays, suggesting careful patient selection is crucial.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Outcomes Research
Background:
- The Tokyo Guidelines 2018 suggest subtotal cholecystectomy (SC) for severe cholecystitis.
- Closure of the cystic duct orifice (CDO) or remnant gallbladder during SC is not always feasible.
Purpose of the Study:
- To compare short-term outcomes of SC with and without closure of the CDO or remnant gallbladder.
- To evaluate the impact of closure techniques on complication rates and length of stay.
Main Methods:
- A retrospective study of 47 patients undergoing SC between 2012-2022.
- Patients were divided into closure (n=35) and non-closure (n=12) groups.
- Primary outcome: Clavien-Dindo (CD) grade ≥II complications; Secondary outcomes: intraoperative events, reinterventions, length of stay, mortality.
Main Results:
- No significant difference in CD grade ≥II or ≥III complications between groups.
- Higher rates of CD grade ≥III bile leakage in the non-closure group (25.0% vs 5.7%).
- Significantly longer length of stay in the non-closure group (median 27.5 days vs 7 days; p<0.001).
Conclusions:
- SC without closure may be suitable for carefully selected patients when closure is not feasible or safe.
- Non-closure is associated with increased length of stay, highlighting the importance of closure when possible.
Purpose:
The Tokyo Guidelines 2018 recommend subtotal cholecystectomy (SC) as a bailout procedure for severe cholecystitis; however, closure of the cystic duct orifice (CDO) or remnant gallbladder is not always feasible. We compared the short-term outcomes of SC with and without such closures.
Methods:
A total of 47 patients who underwent SC at two institutions between 2012 and 2022 were included. The patients were classified into closure (CDO or remnant gallbladder closed; n = 35) and non-closure (neither closed; n = 12) groups. The primary outcome was Clavien-Dindo (CD) grade ≥ II complications. Secondary outcomes included intraoperative events, reinterventions, length of stay, and surgery-related mortality rates.
Results:
The baseline characteristics were similar. CD grade ≥ II and ≥ III complications occurred in 28.6% vs. 41.7% (p = 0.481) and 11.4% vs. 25.0% (p = 0.350) in the closure vs. non-closure groups, respectively. CD grade ≥ III bile leakage was higher in the non-closure group (5.7% vs. 25.0%, p = 0.097). No intraoperative bile duct injuries occurred. The length of stay was longer in the non-closure group (median [IQR], 27.5 [19.8-33] vs. 7 [5-14.5] days; p < 0.001), and mortality was rare.
Conclusion:
SC without closure of the CDO or remnant gallbladder may be reserved for carefully selected patients when closure is infeasible or unsafe.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease