Subtotal Cholecystectomy: Results of a Single-Centre, Registry-Based Retrospective Cohort Study of 180 Adults in 2011–2018

Abstract

Background: Data on subtotal cholecystectomy (STC) as an alternative to conventional cholecystectomy in difficult surgical situations are limited. This multi-aspectual report aims to reduce the STC-specific knowledge gap and inform clinical decision-making strategies. Methods: All 180 patients who underwent STC at a single centre between 2011 and 2017 were assessed in this retrospective cohort study. Their outcomes were followed up until March 23, 2018. Six subgroups stratified by surgical setting (elective/non-elective), surgical approach used (open/laparoscopic), and type of procedure (reconstituting/fenestrating) were compared. Findings: The ratio of conventional to STC procedures during the study period was 13:1. Of the 180 patients, 150 (83%) had a history of hospitalisation for acute biliary disease. The proportion of all cholecystectomies that were STC ranged from 1% to 71% between individual surgeons; similarly, laparoscopic STC comprised 0%–97% of all STCs. STC was associated with high intraoperative and short-term postoperative complication rates (10·6% and 88·0%, respectively). There were three intraoperative complications, comprising one case each of bile duct injury (3·9%), significant bleeding from hepatic vessels (3·3%), and intestinal injury requiring repair (2·2%). The most common postoperative surgical site complications were external bile leak (21%), wound infection (17%), and biloma (10%). Strong associations between fenestrating STC and the rates of postoperative bile leak and retained gallstones, mainly in the main bile duct, were observed. A total of 532 targeted non-invasive and invasive investigations (304 computed tomography scans, 153 endoscopic retrograde cholangiopancreatography scans, 50 magnetic resonance cholangiopancreatography scans, and 25 endoscopic ultrasound scans) were performed. Interpretation: STC is associated with significant intraoperative and postoperative complication rates and a high investigation burden. Injury can be avoided when conversion to STC is timely and its technical variant is correctly selected. The STC rate could be introduced as a quality indicator for gallbladder surgery. Funding: Neither author received specific funding for this work. Declaration of Interests: The authors declare no competing financial interests. Ethics Approval Statement: The institutional clinical audit management board reviewed, approved, and registered the project as a no-risk observational cohort study. Hence, acquisition of informed consent from patients was not required for this study, as it does not include personal information about individual patients.