Laparoscopic Subtotal Cholecystectomy: Conversion is wisdom, not failure in difficult cholecystectomy-It prevents disaster
Department of General Surgery, Government Medical College, Surat, Gujarat, India.
Research Article
International Journal of Frontiers in Medicine and Surgery Research, 2026, 08(01), 001-011.
Article DOI: 10.53294/ijfmsr.2026.8.1.0026
Publication history:
Received on 01 March 2026; revised on 09 April 2026; accepted on 11 April 2026
Abstract:
Introduction: Laparoscopic cholecystectomy is commonly performed procedure in daily surgical practice worldwide in symptomatic gallbladder stone patients. During laparoscopic cholecystectomy, operating surgeons may encounter great difficulty during Calot’s triangle dissection and not able to achieved critical view of safety to proceed safe dissection with preventing common bile duct injury. In that case, we need to identified preoperative risk factors in the form of patient’s factor including comorbidity, no. of pain episode experience before current hospital admission, total number of hospital admission required for same complaints and radiological investigation including ultrasound abdomen-pelvis, CECT-A-P-T, MRCP which collectively indicate difficult cholecystectomy in preoperative periods. Intraoperative surgical findings may necessitate conversion into retrograde gallbladder dissection before doing unsafe calot’s triangle dissection to avoid major catastrophe and performing subtotal cholecystectomy in the form of either fenestrating or reconstituting subtotal cholecystectomy depending upon the condition of cystic duct opening and observing postoperative short term and long-term morbidity.[1]
Methods: We retrospectively reviewed 25 patients who underwent subtotal cholecystectomy in a single unit at our institute during specific time period. Gathered all relevant preoperative, intra operative and post-operative information that predict difficult cholecystectomy during Preoperative as well as intra operative time and observed post operative short term and long term sequences(morbidity and mortality) in patients who underwent subtotal cholecystectomy
Results: We analysed 25 patients who underwent subtotal cholecystectomy using either fenestrating (n-9) or reconstituting (n-16) approaches with regards to post operative bile leak. Patient who underwent Fenestrating subtotal cholecystectomy was associated with higher rate of post operative bile leak as compared to reconstituting subtotal cholecystectomy.Post operative bile leak effectively managed either by conservative management with delayed drain removal or need of postoperative ERCP, USG guided pigtail insertion as well as re-laparoscopic peritoneal lavage with drain placement in a patient who developed signs of bile peritonitis.
Conclusions: Fenestrating subtotal cholecystectomy is associated with higher rate of postoperative bile leak as compared to reconstituting subtotal cholecystectomy but bile leak effectively managed non-operative or operative method. So, both approaches are safe in view of difficult cholecystectomy. We encourage the subtotal cholecystectomy approach in difficult cholecystectomy considering trends in improved short- and long-term outcomes.
Keywords:
Difficult cholecystectomy; Fenestrating; Reconstituting; Subtotal cholecystectomy; Bailout procedure
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