Laparoscopic Subtotal Cholecystectomy Versus Open Conversion as a Bailout Strategy in Complicated Laparoscopic Cholecystectomy

Background: Difficult laparoscopic cholecystectomy (LC), due to inflammation or unclear anatomy, increases complication risk, such as bile duct injury. In such scenarios, surgeons adopt bailout strategies—either laparoscopic subtotal cholecystectomy (LSC) or conversion to open cholecystectomy (OC). In resource-limited settings, evidence comparing these options remains scarce. This study aimed to compare the postoperative outcomes of LSC and OC as bailout strategies for difficult LC in a resource-constrained tertiary care setting in Pakistan. Methods: A comparative cross-sectional study was conducted at Benazir Bhutto Hospital, Rawalpindi, enrolling 34 patients who underwent either LSC (n=28) or OC (n=6) between January 2022 and December 2024. Patients were selected based on intraoperative difficulty criteria. Primary outcome was procedural success; secondary outcomes included bile leakage, surgical site infections, 30-day mortality, and length of hospital stay. Statistical analysis included t-tests and chi-square tests with a 95% confidence interval. Results: Both groups achieved 100% procedural success. No bile leakage, organ space infections, or 30-day mortality occurred in either group. LSC demonstrated significantly shorter operative time (78.4±15.2 min vs. 102.5±18.7 min, p=0.01) and slightly shorter hospital stay. Superficial surgical site infections were fewer in the LSC group but not statistically significant. Conclusion: In resource-limited settings, both LSC and OC offer comparable safety and efficacy. LSC may offer advantages in operative time and invasiveness. Surgeon expertise and intraoperative judgment should guide strategy selection.