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Egbert LK, Cheung D, Yu S, Tan PH, et al. . J Am Coll Surg. April 2026.

This study is a retrospective cohort study of 2,682 adults undergoing subtotal cholecystectomy (SC) for acute cholecystitis between 2012–2021. There was a median follow-up of 2 years (IQR 0.7–4.1), and the cumulative incidence of remnant cholecystitis reached 13.3%. Notably, recurrence was an early phenomenon, with a median time to event of 28 days (IQR 13–91) and 79.7% occurring within 6 months, suggesting that most clinically relevant failures of SC manifest in the early postoperative window. 

Despite this relatively high recurrence rate, only 2.6% (n = 70) required completion cholecystectomy, performed at a median of 103 days (IQR 43–202). However, reoperation carried substantial morbidity: 47.1% of completions were performed open, with a 7.1% bile duct injury rate, compared to 0.3% of all laparoscopic cholecystectomies and 0.9% after index subtotal cholecystectomy in this study. Median length of stay was 3 days (IQR 1–7).

Subtotal cholecystectomy should be used when a critical view of safety can’t be obtained after sufficient dissection to avoid bile duct injury and avoids reoperation in most patients at 2-year follow up. However, the decision for subtotal should not be taken lightly because if re-operation is required, morbidity is significant with a greatly increased risk of bile duct injury.