Subtotal cholecystectomy is an important bailout procedure when a severely inflamed or adherent gallbladder cannot be safely removed in full. Two techniques have been described for closing the gallbladder remnant: the fenestrating method (F-method), using Endoloop ligation, and the reconstituting method (R-method), using barbed sutures.
A retrospective series of 52 patients who underwent laparoscopic subtotal cholecystectomy between January 2022 and December 2025 (33 in the F-method group, 19 in the R-method group) evaluated early postoperative complications as the primary outcome. Patients in the R-method group were significantly older (median 72 vs. 62 years) and had more severe cholecystitis (Tokyo Guidelines grade ≥II: 79.0% vs. 45.5%); unclear anatomy was also more common in this group (84.2% vs. 21.2%).
Closure time was significantly shorter with the F-method (4 vs. 18 minutes). No bile duct injury, bile leakage, or mortality occurred in either group. Among patients who underwent postoperative imaging, remnant gallbladder tissue was found in 35.7% of the R-method group versus 0% of the F-method group. One patient in each group required readmission for a late complication.
The results indicate both techniques are safe but carry distinct complication profiles: the F-method eliminates remnant gallbladder tissue, while the R-method may be more suitable when complete dissection risks injury. Technique selection should be guided by intraoperative findings.
Source: Endoloop Fenestration Versus Barbed Suture Reconstitution in Laparoscopic Subtotal Cholecystectomy: A Comparative Analysis of Complications and Outcomes, Journal of Laparoendoscopic & Advanced Surgical Techniques, 2026.