Laparoscopic subtotal cholecystectomy for difficult gall bladder disease: Outcomes of a reconstituting technique at a tertiary care centre.

Abstract

Introduction: Laparoscopic subtotal cholecystectomy (LSC) serves as a "bailout" technique in difficult intraoperative scenarios, which preserves the advantages of laparoscopy while ensuring patient safety. This study analyses the indications, intraoperative challenges and outcomes of LSC in a tertiary care teaching hospital.

Patients and methods: A retrospective review was conducted of patients who underwent cholecystectomy between June 2021 and November 2024. Patients were categorised into laparoscopic total cholecystectomy (LTC), LSC and laparoscopic converted to open cholecystectomy (LCOC). The primary endpoint was to compare the post-operative morbidity between the three groups using Clavien-Dindo grading system, while secondary outcomes included early and late post-operative outcomes.

Results: Of the 872 patients, 805 (92.3%) underwent LTC, 64 (7.3%) LSC and 3 (0.4%) LCOC. Among LSC cases, 81.3% were Nassar Grade III-IV, reflecting its need in higher intraoperative difficulty. Bile leak occurred in 3 (4.7%) patients of LSC group. LSC showed 52 patients (81.3%) had no complication, 5 (7.8%) had Grade I, 6 (9.3%) Grade II and 1 (1.6%) Grade III complications. The median post-operative hospital stay was longer in LSC (2 days) compared with LCOC (5 days). Two (3.9%) patients in LSC group had stump cholelithiasis with cholecystitis and had to undergo of redo completion cholecystectomy.

Conclusion: LSC should be used cautiously as a bailout procedure reserved for difficult gall bladders when safe dissection is not possible, rather than as a risk-free substitute for standard cholecystectomy, because it was associated with lower risk of bile duct injury but carries its own long-term morbidity.