63 Does Technique Matter? A Comparison of Subtotal Cholecystectomy Approaches and Their Outcomes

Abstract Aim Laparoscopic subtotal cholecystectomy (LSTC) is a recognised bailout procedure when safe dissection of Calot’s triangle is not feasible, reducing the risk of bile duct injury. This study compares outcomes between fenestrating and reconstituting LSTC techniques. Method This multicentre retrospective cohort study included consecutive adult patients who underwent elective or emergency cholecystectomy across three hospitals within a single health board from August 2023 to July 2024. Patients undergoing LSTC were identified. Data collected included demographics, operative details, and postoperative outcomes, including readmission rates. Outcomes were compared between fenestrating and reconstituting LSTC techniques. Results Of 564 patients, 53 (9.4%) underwent LSTC, including 31 (58.5%) emergency cases. The median age was 59 years (IQR 52–67), and 29 (54.7%) were female. Nine patients (17%) had intraoperative cholangiography, and three (5.7%) underwent bile duct exploration. Thirty-seven (69.8%) had reconstituting LSTC and 16 (30.2%) had fenestrating LSTC.Reconstituting LSTCN=37Fenestrating LSTCN=16P valuePost-op CT scan1440.530Post-of MRCP610.661Post-op ERCP1470.764Post-op IR drainage110.517Median post-op hospital stay5 days (IQR 3-9)4 days (IQR 3-7)0.643Complications941.00030-day readmission311.000 Conclusions There was no significant difference in outcomes between techniques. Surgeons should employ the approach with which they are most confident.