Clinical Outcomes and Complications Following Subtotal Cholecystectomy: A Single-Centre Cohort Analysis

Background Subtotal cholecystectomy (STC) is increasingly used as a safe technique for managing difficult gallbladders to reduce the risk of common bile duct (CBD) injury. However, techniques and outcomes vary across institutions, and standardised reporting remains limited. Objective To evaluate peri-operative and post-operative outcomes following STC at a single tertiary centre and to explore pre-operative factors associated with the need for STC, including the frequency of previous gallstone-related admissions and radiologic markers such as impacted infundibular or neck stones, thickened or contracted gallbladder, and imaging features suggestive of a frozen Calot's triangle. Methods Retrospective cohort study of consecutive patients undergoing STC between January 2021 and January 2024. Data included demographics, indications, operative technique (fenestrating vs. reconstituting), intra-operative findings, complications, and long-term biliary outcomes. The primary endpoint was clinically significant bile leak; secondary outcomes were reoperation, endoscopic retrograde cholangiopancreatography (ERCP) requirement, readmission, and mortality. Results Thirty-nine patients underwent STC (97% laparoscopic, 3% open). Median age 49 years with a mean BMI of 39 kg/m². Bile leak occurred in 2.6% (n = 1), reoperation 0%, ERCP 2.6% (n = 1), readmission 0%, and mortality 0%. Conclusions STC offers a safe alternative to total cholecystectomy in complex cases, though bile leak remains an important morbidity. Technique type and intra-operative factors influence outcomes, highlighting the need for standardised approaches and careful case selection.