Year: 2026 | Month: June | Volume: 13 | Issue: 6 | Pages: 621-631
DOI: https://doi.org/10.52403/ijrr.20260660
Subtotal Cholecystectomy in Difficult Gallbladder Surgeries: A Retrospective Observational Study
Dr. M. Shanmuga Priyan1, Dr. Gulamnabi2, Dr. Srinivas Yadav3
1Postgraduate Resident, Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
2Professor, Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
3Senior Resident, Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
Corresponding Author: Dr. M. Shanmuga Priyan
ABSTRACT
Background: Laparoscopic cholecystectomy is the gold standard for symptomatic cholelithiasis; however, severe inflammation, fibrosis, or anatomical distortion of the hepatocystic triangle can preclude safe achievement of the critical view of safety. In such situations, subtotal cholecystectomy (STC) is increasingly recognised as a bailout procedure to minimise bile duct injury. The present study reviewed the institutional experience with STC for the difficult gallbladder.
Methods: A retrospective observational study was conducted at Sapthagiri Institute of Medical Sciences and Research Centre over a 72-month period from April 2020 to March 2026. Records of patients aged 18 years or older who underwent cholecystectomy for symptomatic cholelithiasis or cholecystitis were reviewed. Patients with malignant gallbladder disease, concomitant biliary or hepatic resections, and incomplete records were excluded. Demographic data, comorbidities, history of cholecystitis, preoperative endoscopic retrograde cholangiopancreatography, intraoperative findings and postoperative outcomes were extracted and compared between the total cholecystectomy and the subtotal cholecystectomy groups.
Results: A total of 900 cholecystectomies were performed during the study period, of which 15 (1.67%) were STC. Of the STC cohort, 13 (86.7%) were of the reconstituting subtype and 2 (13.3%) were fenestrating; 12 (80.0%) were completed laparoscopically while 3 (20.0%) required conversion to open. The mean age in the STC group was 51.4 years compared with 44.6 years in the TC group, with a male preponderance in the STC group (53.3% vs 30.5%). A prior history of cholecystitis (53.3% vs 12.1%), choledocholithiasis with ERCP (26.7% vs 3.2%) and biliary pancreatitis (20.0% vs 1.9%) was more frequent in the STC group. No bile duct injury or complete biliary transection requiring hepaticojejunostomy occurred in either group. Postoperative bile leak occurred in 3 (20.0%) STC patients and 2 (0.2%) TC patients; the mean hospital stay was 5.3 days in the STC group versus 2.2 days in the TC group.
Conclusion: Subtotal cholecystectomy is a safe and effective bailout procedure for the difficult gallbladder, achieving a zero rate of bile duct injury at the expense of an acceptable increase in bile leak, drain duration and hospital stay. Liberal adoption of subtotal cholecystectomy, particularly the reconstituting subtype, is advocated when the critical view of safety cannot be achieved.
Keywords: Subtotal cholecystectomy; difficult gallbladder; laparoscopic cholecystectomy; bile duct injury; bailout procedure; critical view of safety.
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