The Safety of Subtotal over Total Cholecystectomy: A Systematic Review

Abstract

Subtotal cholecystectomy (STC) is a promising alternative to total cholecystectomy (TC) for gallbladder procedures, with research showing a reduced incidence of bile duct damage. However, concerns persist regarding residual gallbladder tissue post-STC, potentially leading to serious postoperative complications like bile leakage. This study aimed to critically assess the safety profile of STC versus TC based on a thorough analysis of the current literature. A systematic review was conducted, involving eight studies from 2012-2024, involving human subjects. The review found that STC demonstrated distinct advantages and disadvantages compared to TC, manifesting differences in complication rates, postoperative outcomes, and healthcare resource utilization. Cumulative evidence suggests that STC may present advantages in select scenarios, such as a reduced risk of common bile duct injury. However, STC is also associated with elevated rates of certain postoperative complications, underscoring the need for careful consideration when opting for this approach. In contrast, TC appears to demonstrate lower rates of specific complications like bile leaks and subhepatic fluid collections. Surgeons should carefully consider the trade-offs between STC and TC based on the complexity of the cholecystectomy case and the associated risks and benefits of each procedure. Further research and ongoing evaluation are necessary to refine the understanding of the safety profile of subtotal cholecystectomy.