Endoloop Fenestration Versus Barbed Suture Reconstitution in Laparoscopic Subtotal Cholecystectomy: A Comparative Analysis of Complications and Outcomes

Abstract

Background:

Subtotal cholecystectomy is an important bailout procedure for difficult cholecystitis cases. Two novel closure techniques have been described: the fenestrating method (F-method) using Endoloop ligation and the reconstituting method (R-method) using barbed sutures. This study aimed to compare the short- and long-term outcomes of these two techniques.

Methods:

This retrospective study included 52 patients who underwent laparoscopic subtotal cholecystectomy between January 2022 and December 2025, with 33 patients in the F-method group and 19 patients in the R-method group. The primary outcome was early postoperative complications. The secondary outcomes included late complications, operative time, and remnant gallbladder tissue on imaging.

Results:

Patients in the R-method group were significantly older (median: 72 versus 62 years, P = .021) and had more severe cholecystitis (Tokyo Guidelines grade ≥ II: 79.0% versus 45.5%, P = .023). Unclear anatomy was more common in the R-method group (84.2% versus 21.2%, P < .0001). Closure time was significantly shorter in the F-method group (4 versus 18 minutes, P < .0001). No bile duct injury, bile leakage, or mortality was observed in either group. Among patients who underwent postoperative imaging, remnant gallbladder tissue was identified in 35.7% of patients in the R-method group and 0% in those in the F-method group (P = .012). One patient in each group developed late complications that required readmission (F-method, common bile duct stone; R-method, remnant cholecystitis).

Conclusions:

Both methods are safe and have distinct complication profiles. The F-method eliminates remnant gallbladder tissue, whereas the R-method is suitable when complete dissection poses a risk of injury. Technique selection should be based on intraoperative findings.