Subtotal Cholecystectomy: A Safe Approach in Difficult Cholecystectomy

Background: Subtotal cholecystectomy is a surgical proce-dure designed for situations where a traditional cholecystecto-my becomes difficult or unsafe due to anatomical variations or severe inflammation of the gallbladder. This approach is intend-ed to manage challenging cases while minimizing the risks as-sociated with complications. The procedure involves removing as much of the gallbladder as safely as possible, to avoid injury of critical structures like the common bile duct or hepatic artery. This is often necessary when it is difficult to clearly identify and dissect the anatomy of calot triangle clearly and cannot achieve the critical view of safety. Aim of Study: Investigate the safety and efficacy of subtotal cholecystectomy in challenging cases by examining outcomes of patients who undergo this procedure. Patients and Methods: Prospective cohort observational study at Ain Shams University Hospitals and Itay Elbaroud General Hospital on 20 patients between December 2023 and July 2024. Results: The age ranged from 21 to 68 years with a mean value of 52.8 (±12.7) years. 11 (55%) patients were males, and 9 (45%) patients were females. Regarding type of operation, 16 (80%) patients underwent laparoscopic operation and 4 (20%) patients converted to open operation. Regarding comorbidities, diabetes mellitus (DM) was present in 4 (20%) patients, hyper-tension was present in 8 (40%) patients and ischaemic heart disease was present in 3 (15%) patients. Regarding diagnosis, acute cholecystitis was present in 9 (45%) patients, chronic cholecystitis was present in 3 (15%) patients, gallbladder em-pyema was present in 5 (25%) patients, history of cholangitis was present in 1 (5%) patient and Mirizzi’s syndrome was pres-ent in 2 (10%) patients. The Operative time ranged from 45 to 105min with a mean value of 68.5 (±19.87) min. HB was slight-ly decresed in postoperative than preoperative while leukocytes and CRP were significantly higher postoperative than preopera-tive. AST, and ALT were significantly higher postoperative than preoperative while ALP, GGT, and bilirubin were insignificant-ly different between preoperative and postoperative. The length of hospital stay ranged from 2 to 12 days with a mean value of 4.5 (±2.4) days. Conclusion: The subtotal cholecystectomy was found to be a modified technique (bail-out procedure) that aims to over-come complications in complex and severely inflamed cases and improve patient outcomes. Also, it was found to be a rela-tively safe approach with minor complications.