249 Bile Leak After Laparoscopic Subtotal Cholecystectomy with an Open Versus Closed Gallbladder Remnant

Abstract Aim Subtotal cholecystectomy (STC) is a sometimes unavoidable measure when dissection of Calot’s structures is deemed unsafe. The GB remnant is at risk of postoperative bile leak even when closed (Purzner 1a, 1b), but some advocate leaving it open (Purzner 2a, 2b, 3) to prevent recurrent cholecystitis. This study compares the rate of bile leak with an open versus closed GB remnant at subtotal cholecystectomy. Method A retrospective review was carried out on all STC performed by three Upper GI surgeons between 2018 and 2025. Outcomes were compared between Purzner Grade 1 (closed) vs Grade 2 and 3 (open). These included bile leak, postoperative ERCP requirement, postoperative length of stay (LOS), and readmission to hospital. Results 28 patients underwent laparoscopic STC during the study period, of which only one was converted to open (3.6%). The GB remnant was closed in 14 patients (50%) and left open in 14 patients (50%). Whilst no statistically significant differences were found between the two groups; the rate of bile leak was higher in the open group (100% vs 79%, p=0.07), as was LOS (8 days vs 5 days, p=0.15). However, the need for postoperative ERCP (28% vs 36%, p=0.65) and return to theatre (7% vs 7%, p=1.0) was similar. Readmissions were higher in the closed group (29% vs 7%, p=0.13). Conclusions Bile leak and the need for postoperative ERCP are common after both open and closed management of the GB remnant at STC. Consideration of long-term sequelae like recurrent cholecystitis should factor into the choice of technique.