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Purpose <p>The Tokyo Guidelines 2018 recommend subtotal cholecystectomy (SC) as a bailout procedure for severe cholecystitis; however, closure of the cystic duct orifice (CDO) or remnant gallbladder is not always feasible. We compared the short-term outcomes of SC with and without such closures.</p> Methods <p>A total of 47 patients who underwent SC at two institutions between 2012 and 2022 were included. The patients were classified into closure (CDO or remnant gallbladder closed; <i>n</i> = 35) and non-closure (neither closed; <i>n</i> = 12) groups. The primary outcome was Clavien–Dindo (CD) grade ≥ II complications. Secondary outcomes included intraoperative events, reinterventions, length of stay, and surgery-related mortality rates.</p> Results <p>The baseline characteristics were similar. CD grade ≥ II and ≥ III complications occurred in 28.6% vs. 41.7% (<i>p</i> = 0.481) and 11.4% vs. 25.0% (<i>p</i> = 0.350) in the closure vs. non-closure groups, respectively. CD grade ≥ III bile leakage was higher in the non-closure group (5.7% vs. 25.0%, <i>p</i> = 0.097). No intraoperative bile duct injuries occurred. The length of stay was longer in the non-closure group (median [IQR], 27.5 [19.8–33] vs. 7 [5–14.5] days; <i>p</i> &lt; 0.001), and mortality was rare.</p> Conclusion <p>SC without closure of the CDO or remnant gallbladder may be reserved for carefully selected patients when closure is infeasible or unsafe.</p>

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Cystic duct management in subtotal cholecystectomy: is closure necessary?

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Kenichi Ishibayashi,
  • Kaichiro Kato,
  • Satoshi Takada,
  • Mitsuyoshi Okazaki,
  • Yoshinao Ohbatake,
  • Hirotaka Kitamura,
  • Shinichi Nakanuma,
  • Isamu Makino,
  • Shinichi Kadoya,
  • Shintaro Yagi

摘要

Purpose

The Tokyo Guidelines 2018 recommend subtotal cholecystectomy (SC) as a bailout procedure for severe cholecystitis; however, closure of the cystic duct orifice (CDO) or remnant gallbladder is not always feasible. We compared the short-term outcomes of SC with and without such closures.

Methods

A total of 47 patients who underwent SC at two institutions between 2012 and 2022 were included. The patients were classified into closure (CDO or remnant gallbladder closed; n = 35) and non-closure (neither closed; n = 12) groups. The primary outcome was Clavien–Dindo (CD) grade ≥ II complications. Secondary outcomes included intraoperative events, reinterventions, length of stay, and surgery-related mortality rates.

Results

The baseline characteristics were similar. CD grade ≥ II and ≥ III complications occurred in 28.6% vs. 41.7% (p = 0.481) and 11.4% vs. 25.0% (p = 0.350) in the closure vs. non-closure groups, respectively. CD grade ≥ III bile leakage was higher in the non-closure group (5.7% vs. 25.0%, p = 0.097). No intraoperative bile duct injuries occurred. The length of stay was longer in the non-closure group (median [IQR], 27.5 [19.8–33] vs. 7 [5–14.5] days; p < 0.001), and mortality was rare.

Conclusion

SC without closure of the CDO or remnant gallbladder may be reserved for carefully selected patients when closure is infeasible or unsafe.