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Introduction <p>Laparoscopic cholecystectomy remains the gold-standard treatment for symptomatic gallbladder disease; however, in situations where safe dissection is not achievable, subtotal cholecystectomy has emerged as a reliable alternative to minimize operative risk. Given the technical differences between the reconstituting and fenestrating approaches and the inconsistent evidence regarding their postoperative outcomes, this systematic review and meta-analysis was designed to provide a comprehensive comparison of these two surgical techniques. The present study incorporates more recently published studies and provides an updated synthesis of the available evidence.</p> Materials and methods <p>This study was conducted as a systematic review and meta-analysis in accordance with PRISMA guidelines. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, Google Scholar, SID, Magiran, and IranMedex using relevant MeSH terms and keywords. The literature search was conducted up to December 2025. Eligible studies were systematically analyzed using random-effects meta-analysis; risk of bias was assessed using the Newcastle-Ottawa Scale, and results were visualized using the ROBVIS tool.</p> Results <p>Thirteen studies involving 950 patients (reconstituting: <i>n</i> = 324; fenestrating: <i>n</i> = 626) were included. Reconstituting subtotal cholecystectomy was associated with a significantly lower incidence of postoperative bile leak compared with the fenestrating technique (OR = 0.29, 95% CI 0.16–0.55; <i>P</i> = 0.0002; I² =34%). No statistically significant differences were observed for postoperative ERCP (OR = 0.43, 95% CI 0.17–1.07; <i>P</i> = 0.071; I² = 64.7%) or reoperation rates (OR = 0.55, 95% CI 0.19–1.61; <i>P</i> = 0.276; I² = 0%).</p> Conclusion <p>Based on low-certainty GRADE evidence, this meta-analysis indicates that reconstituting subtotal cholecystectomy is associated with a significantly lower risk of postoperative bile leak compared with the fenestrating technique, with low-to-moderate heterogeneity. Although the overall direction of effect for postoperative ERCP and reoperation also favored the reconstituting technique, these differences did not reach statistical significance, likely reflecting limited statistical power and heterogeneity; these results should be considered hypothesis-generating. Overall, the reconstituting technique appears to offer a safer postoperative profile, though confirmation by prospective studies is warranted.</p>

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Postoperative outcomes of reconstituting versus fenestrating subtotal cholecystectomy: a systematic review and meta-analysis of observational studies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月11日

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  • Behnam Reza Makhsosi,
  • Pourya Ghobadi,
  • Amir Tarighinia,
  • Tara Mazaheri,
  • Leila Solouki

摘要

Introduction

Laparoscopic cholecystectomy remains the gold-standard treatment for symptomatic gallbladder disease; however, in situations where safe dissection is not achievable, subtotal cholecystectomy has emerged as a reliable alternative to minimize operative risk. Given the technical differences between the reconstituting and fenestrating approaches and the inconsistent evidence regarding their postoperative outcomes, this systematic review and meta-analysis was designed to provide a comprehensive comparison of these two surgical techniques. The present study incorporates more recently published studies and provides an updated synthesis of the available evidence.

Materials and methods

This study was conducted as a systematic review and meta-analysis in accordance with PRISMA guidelines. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, Google Scholar, SID, Magiran, and IranMedex using relevant MeSH terms and keywords. The literature search was conducted up to December 2025. Eligible studies were systematically analyzed using random-effects meta-analysis; risk of bias was assessed using the Newcastle-Ottawa Scale, and results were visualized using the ROBVIS tool.

Results

Thirteen studies involving 950 patients (reconstituting: n = 324; fenestrating: n = 626) were included. Reconstituting subtotal cholecystectomy was associated with a significantly lower incidence of postoperative bile leak compared with the fenestrating technique (OR = 0.29, 95% CI 0.16–0.55; P = 0.0002; I² =34%). No statistically significant differences were observed for postoperative ERCP (OR = 0.43, 95% CI 0.17–1.07; P = 0.071; I² = 64.7%) or reoperation rates (OR = 0.55, 95% CI 0.19–1.61; P = 0.276; I² = 0%).

Conclusion

Based on low-certainty GRADE evidence, this meta-analysis indicates that reconstituting subtotal cholecystectomy is associated with a significantly lower risk of postoperative bile leak compared with the fenestrating technique, with low-to-moderate heterogeneity. Although the overall direction of effect for postoperative ERCP and reoperation also favored the reconstituting technique, these differences did not reach statistical significance, likely reflecting limited statistical power and heterogeneity; these results should be considered hypothesis-generating. Overall, the reconstituting technique appears to offer a safer postoperative profile, though confirmation by prospective studies is warranted.