Outcomes of Fenestrating vs. Reconstituting Laparoscopic Subtotal Cholecystectomy: A Single-Center Retrospective Study

<b>Background</b>: Laparoscopic subtotal cholecystectomy (LSTC), either fenestrating or reconstituting, offers potential benefits for the "difficult gallbladders" in terms of reduced bile duct injury (BDI) risk. <b>Methods</b>: This single-center retrospective cohort study analyzed data from patients who underwent reconstituting or fenestrating LSTC at a tertiary care center. We excluded patients who were converted to open cholecystectomy or had incomplete medical records. The data examined included demographic and clinical characteristics, preoperative assessments, operative details, and postoperative outcomes. No multivariable regression was performed because of the limited sample size. <b>Results</b>: The study included 46 patients (reconstituting: 20 patients; fenestrating: 26 patients). The severity of cholecystitis assessed by the Tokyo guidelines showed a higher proportion of Grade 2 severity in the reconstituting group than the fenestrating group (90% vs. 56.5%; <i>p</i> = 0.027). Both surgical techniques were similarly challenging and showed no significant differences in operative difficulty, operative duration, blood loss, or total hospital stay. Fenestrating procedures had non-significantly higher incidences of BDI (7.7% vs. 0%; <i>p</i> = 0.21), bile leakage (23.1% vs. 10%; <i>p</i> = 0.246), and intraoperative drain placement (88.5% vs. 75%; <i>p</i> = 0.232). Postoperative complications such as bile leaks were also comparable between the two techniques. Nevertheless, given the small sample, these observations are descriptive and should not be interpreted as evidence of comparability or superiority. <b>Conclusions</b>: Despite limitations, our analysis suggests that fenestrating and reconstituting approaches have comparable postoperative outcomes, although fenestrating procedures were associated with slight but non-significant increases in BDI and drain placement due to leaks. The choice of LSTC technique should depend on intraoperative findings, surgical expertise, and familiarity with each technique, but further studies are needed to obtain firm conclusions.