Subtotal cholecystectomy as a bailout strategy in difficult cholecystectomy: Outcomes and patient selection criteria

Backgrounds/Aims: Subtotal cholecystectomy is a salvage procedure when critical safety margins cannot be achieved in difficult cases. This study evaluated the impact of surgical approach and technique on short- and long-term outcomes. Methods: A retrospective review of 101 patients who underwent subtotal cholecystectomy between January 2010 and November 2024 was conducted. Patients were grouped by approach: laparoscopic (n = 42), open (n = 31), and conversion (n = 28). Techniques were classified as fenestrating or reconstituting. Complications were assessed using the Clavien-Dindo classification. Logistic regression identified risk factors, and Cox regression evaluated long-term outcomes. Intention-to-treat analysis was performed. Results: = 0.018). No stone recurrence was observed. Conclusions: Subtotal cholecystectomy is a safe option in complex cases. Outcome differences are likely related to patient selection rather than technique. Technique selection should be based on intraoperative findings.