TTP4.07 Laparoscopic Subtotal Cholecystectomy: A Blessing or a Burden?

Aim Laparoscopic subtotal cholecystectomy (LSTC) is a well-recognized bailout procedure used when the hepatocystic triangle is unfavourable, reducing the risk of bile duct injury (BDI). This study aims to analyze the outcomes following LSTC. Methods This multicentre retrospective study included consecutive adult patients undergoing elective and emergency cholecystectomy at three hospitals within a single health board from August 2023 to July 2024. Data collected encompassed patient demographics, operative details, and postoperative outcomes, including readmission rates. Results A total of 564 patients were identified, with a median age of 53 years, and 404 (71.6%) were female. Of these, 210 (37.2%) were emergency cases. Intra-operative cholangiogram was performed in 212 (37.6%) patients, and 72 (12.8%) underwent common bile duct exploration. Among the cohort, 34 (6%) patients had LSTC, including 19 (55.9%) emergency cases. Seven (20.6%) had an intra-operative cholangiogram via the trans-vesical route, and two (5.9%) underwent successful bile duct exploration. All patients required sub-hepatic surgical drain placement, and 13 (38.2%) required Endoscopic Retrograde Cholangiopancreatography (ERCP). The median length of postoperative stay was significantly longer in the LSTC group (5 days vs. 1 day, p<0.001). Conclusion Laparoscopic subtotal cholecystectomy (LSTC) is an effective technique for preventing bile duct injury (BDI) in complex cholecystectomy cases. However, perioperative morbidity associated with LSTC is relatively high. Surgeons must be aware of these risks, take steps to minimize them, and provide thorough patient counselling.