Subtotal cholecystectomy for difficult gall bladder due to chronic cholecystitis: a retrospective cohort study

Background: Subtotal cholecystectomy (STC) is a valuable technique when severe inflammation, fibrosis, or anatomical variations obscure the critical view of safety essential for identifying the cystic duct and artery. It helps reduce the risk of bile duct injuries and other complications that arise during a total cholecystectomy (TC) when these structures are not visible. Aim: This study was conducted to review our single-center experience with STC for chronic cholecystitis. Methods: A single-center, retrospective cohort study was conducted on 1149 patients who underwent cholecystectomy between May 2021 and November 2024. Demographics, clinical characteristics, and postoperative outcomes (median follow-up 22 months) of STC were compared with TC. Results: 38 (3.3%) of the 1149 cholecystectomies were STCs (36 reconstituting and two fenestrating types). 29 (76.3%) of STCs were performed laparoscopically. History of cholecystitis (47.4% vs 1.9%, p = 0.001), choledocholithiasis (21.1% vs 2.9%, p = 0.001), and biliary pancreatitis (28.9% vs 1.8%, p = 0.001) were significantly higher in patients undergoing STC than in those undergoing TC. There was no bile duct injury in either group. On a median follow-up of 22 months, no recurrent stone formation was noted in the remnant gallbladder in the STC group. There was no BDI or mortality in either group. Conclusion: STC is a safe bailout procedure in a difficult laparoscopic cholecystectomy, especially in those with a history of cholecystitis, choledocholithiasis, and biliary pancreatitis.