Subtotal Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography: A Colossal Synergy

Authors

  • Adolfo García Ramírez Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Karen Estefania Martinez Salgado Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Rosa Isela Garcia Padilla Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Hidalgo
  • Aldebharan Avila Ríos Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Octavio Orduña Domínguez Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Chiapas
  • Brenda Sujey Morales Cruz Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Guadalajara
  • Sergio Fernández Zenteno Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Hidalgo
  • Carlos Iván Díaz Terrones Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Triana Cioltzil Basave Felipe Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Jesús Ricardo Delgado Gómez Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Katia Berenice Pineda Miranda Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Aleksander Eduardo Inocencio Ocampo Specialist in Surgery. Attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico
  • Alfredo Barrera Zavala Surgery Specialist. Head of the Department of Surgery at the “Dr. Rubén Leñero” General Hospital of the Mexico City Health Department. Graduate of the National Autonomous University of Mexico
  • Pamela Navarro Hernández Specialist in Surgery and Gastrointestinal Endoscopist. Attached to the Department of Endoscopy of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico. Mexico
  • Morelos Adolfo García Sánchez Specialist in Surgery and with a subspecialty in Colon and Rectal Surgery attached to the Department of Surgery of the General Hospital Ministry of Health of Mexico City "Dr. Rubén Leñero". Graduated from the National Autonomous University of Mexico, Mexico City. Country Mexico

DOI:

https://doi.org/10.14738/bjhr.1204.19237

Keywords:

Acute cholecystitis, Gall bladder, Subtotal cholecystectomy, Fenestrant, Reconstitute, Cholecystectomy, Endoscopic retrograde cholangiopancreatography

Abstract

Introduction: acute cholecystitis disease is defined as inflammation of the gallbladder and is more common in women. Objective: to report the experience of endoscopic retrograde cholangiopancreatography in patients with biliary pathology with partial cholecystectomies. Method: retrospective, longitudinal, descriptive and observational study with descriptive statistical analysis in patients with endoscopic retrograde cholangiopancreatography who underwent surgery by partial cholecystectomy Results: 110 patients with endoscopic retrograde cholangiopancreatography with cholecystectomy were identified, which are 72.8% of the 151 studies performed. Of these group 95 women who are 86.36% and 15 men who represent 13.63% with a male-female ratio of 6:1. The average age was 46 years with a range of 18 to 75 years. Adjusted morbidity was concluded at 60% and there was no mortality. Discussion: subtotal cholecystectomy is the removal of as much of the gallbladder as possible, intentionally leaving a portion of it in situ, making it a viable alternative for complex cases of acute or chronic gallbladder inflammation and subclassifying it into fenestrant and restorative. Conclusions: partial cholecystectomy, whether laparoscopic or conventional, is justified in a difficult cholecystectomy, in an emergency surgery and in the absence of the basic and correct supplies/resources, both to perform an obligatory trans operative cholangiography or even an endoscopic retrograde cholangiopancreatography.

References

Universidad Mayor San Simón Bolivia. Historia de la colecistitis. 2023. Revisado en: https://www.studocu.com/bo/document/universidad-mayor-de-san-simon/patologiaespecial/colecistitisaguda/54500706

Ellis H. John Stough Bobbs: father of gall bladder surgery. Br J Hosp Med (Lond). 2009; 70(11):650, doi: 10.12968/hmed.2009.70.11.45057.

Burmeister G., Hinz S., Schafmayer C. Die akute Cholezystitis [Acute Cholecystitis]. Zentralbl Chir. 2018; 143(4):392-399. 287

Walsh K., Goutos I., Dheansa B. Acute Acalculous Cholecystitis in Burns: A Review. J Burn Care Res. 2018; 39(5):724-728.

García-Hernández J.L., García-Sánchez M.A., Méndez-Barrón G., et al. Abdominal Sepsis in Surgery and does this "Diagnosis" Really Exist? Effective Surgical TherapyBritish Journal of Healthcare and Medical Research .2025; 12;(2): 449-469.

Salas-Segura C.A., Hernández-Medina, M. S., López-Sixtos, J. R., Arcos-Ruiz, C., & García-Sánchez, M. A. Bleeding in Surgery. British Journal of Healthcare and Medical Research. 2025; 12(04):12-30.

Dewana A.M., Namq A.J., Ahmed B.S., Baban A.A. Optimal timing for cholecystectomy: unveiling insights from a decade-long study on acute cholecystitis and symptomatic cholecystolithiasis. BMC Surg. 2025; 25(1):199.

Blythe J., Herrmann E., Faust D., et al. Acute cholecystitis - a cohort study in a real-world clinical setting (REWO study, NCT02796443). Pragmat Obs Res. 2018; 9:69-75.

Loza-Avalos S.E., Isenberg E.E., Cheng M., et al. An Exploration of Food Deserts and Acute Biliary Disease in Emergency General Surgery Patients. J Surg Res. 2025; 309:80-87.

David G.G., Al-Sarira A.A., Willmott S., et al. Management of acute gallbladder disease in England. Br J Surg. 2008; 95(4):472-6.

Gaurang Garg., Yacob G.. Tedla., Anika S. et al. Supermarket Proximity and Risk of Hypertension, Diabetes, and CKD: A Retrospective Cohort Study, American Journal of Kidney Diseases. 2023; 81(2):168-178.

Börner N., Kappenberger A.S., Weber S., et al. The Acute Abdomen: Structured Diagnosis and Treatment. Dtsch Arztebl Int. 2025; 122(5):137-144.

Jia F., Ma Y., Liu Y. Association of milk consumption with the incidence of cholelithiasis disease in the US adult population. BMC Public Health. 2023; 23(1):1639.

Gao Y., Mao K., Yang C., et al. The Causal Relationship Between Choline Metabolites and Acute Acalculous Cholecystitis: Identifying ABCG8 as Colocalized Gene. Nutrients. 2024; 16(21):3588.

Wu J.R., Wang C.C., Li B.Y., et al. Concomitant functional gallbladder disorder and left-sided gallbladder: A case report. World J Gastrointest Endosc. 2025; 17(7):107059. doi: 10.4253/wjge.v17.i7.107059.

Liu Y, Yang X, Liang L, Yao B, Yang X. Laparoscopic cholecystectomy for duplication of the gallbladder: A case report. Int J Surg Case Rep. 2025 Jul;132:111487. doi: 10.1016/j.ijscr.2025.111487.

Zhou S.Y., Zhan X., Li S.Y. Prompt distinction of Alagille syndrome and biliary Atresia in infants: a comparative study. BMC Pediatr. 2025; 25(1):543. doi: 10.1186/s12887-025-05896-y.

Aslanov A.D., Kalibatov R.M., Tilov K.I, et al. Klinicheskii sluchai variantnoi anatomii zhelchnogo puzyrya [Variant anatomy of the gallbladder]. Khirurgiia (Mosk). 2025; (7):98-102.

Mouzakis O., Konidis E., Poulokefalos P., Arnaoutos S.S. Anatomical Challenges in Laparoscopic Cholecystectomy: Five Arterial Branches from a Right Hepatic Caterpillar Hump. Am J Case Rep. 2025; 26: e947240.

Zhou S.H., Li Z.H., Wei Y.C., et al. Laparoscopic cholecystectomy for triple gallbladder malformation: A comprehensive case report and literature review. Medicine (Baltimore). 2025; 104(2):e41190.

Neitzel E., Laskus J., Mueller. P.R., et al. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med. 2025; 40(9):919-928.

Hassanesfahani M., Villavarajan B., Otusile I., et al. Between guidelines and reality; the complex decisionmaking of acute cholecystitis in pregnancy. Langenbecks Arch Surg. 2025; 410(1):211. doi: 10.1007/s00423-025-03768-8.

Gargallo-Puyuelo C.J., Aranguren F.J., Simón-Marco M.A. Emergencias en gastroenterología y hepatología. Gastroenterologia continuada. 2011; 11 (1): 49-52.

Ishii S., Hosoda J., Iguchi K., et al. A case of acute acalculous cholecystitis after pulmonary vein isolation-novel phenotype of perioesophageal vagal nerve injury: a case report. Eur Heart J Case Rep. 2025; 9(5):ytaf204. 288

Monestes J., Galindo F. Colecistitis aguda. Cirugía digestiva. F. Galindo, www.sacd.org.ar, 2009; IV-441, pág. 1-8.

Sun R.T., Li C.L., Jiang Y.M., et al. A radiomics-clinical predictive model for difficult laparoscopic cholecystectomy based on preoperative CT imaging: a retrospective single center study. World J Emerg Surg. 2025; 20(1):62. doi: 10.1186/s13017-025-00635-1.

Abu Hijleh A., Khalid F., Abdalbari K., Yousaf S. Biliary Hyperkinesia: An Overlooked Cause of Right Upper Quadrant Pain. Cureus. 2025; 17(4):e81875.

Slomowitz E., Cooper L., Tsivion-Visbord H., et al. Outcomes of Percutaneous Cholecystostomy in Older Adults with Acute Cholecystitis. Isr Med Assoc J. 2025; 27(4):249-254.

Scalvini D., Mauro A., Mazza S., et al. Same-session endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with lumen-apposing metal stent and rendezvous for biliary stones in invisible papilla. Endoscopy. 2025; 57(S 01):E400-E401.

Moreira E., Ojeda J., Silvera P., et al. Acute Cholecystitis Management in Uruguay: Retrospective Study on Surgical Outcomes and Risk Factors. J Surg Res. 2025; 313:356-362

Le K.L., Pham T.Q., Pham P.C., et al. Optimal timing of laparoscopic cholecystectomy after percutaneous gallbladder drainage in patients with acute calculous cholecystitis: A retrospective comparative study. Ann Hepatobiliary Pancreat Surg. 2025, doi: 10.14701/ahbps.25-062.

Kehoe J.D., O'Connell R., Linehan E., et al. The effect of timing of emergency cholecystectomy for acute cholecystitis on peri-operative outcomes: A national registry-based study. Surgeon. 2025: S1479-666X(25)00120-9.

O'Connell R.M., Hardy N., Ward L., et al, Management and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study. The Surgeon. 2024; 22(6): 364-368,

Faisal M.S., Harris K.B., Faisal M.S., et al. Cystic Duct Stenting Versus Other Treatment Modalities for the Management of Acute Cholecystitis in Patients with Decompensated Cirrhosis. Dig Dis Sci. 2025, doi: 10.1007/s10620-025-09163-z.

Noguchi D., Hayasaki A., Ito T., et al. A new framework for tailoring laparoscopic cholecystectomy: Integrating preoperative clinical factors with surgical difficulty based on the Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2025; 32(6):452-464.

Ramírez-Giraldo C., Torres-Cuellar A., Van-Londoño I. State of the art in subtotal cholecystectomy: an overview. Frontier Surgery. 2023; 10., |https://doi.org/10.3389/fsurg.2023.1142579

Borzellino G., Khuri S., Pisano M., et al. Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results. World J Emerg Surg. 2020; 15:1. doi: 10.1186/s13017-019-0285-7.

Lunevicius R. Review of the Literature on Partial Resections of the Gallbladder, 1898-2022: The Outline of the Conception of Subtotal Cholecystectomy and a Suggestion to Use the Terms 'Subtotal Open-Tract Cholecystectomy' and 'Subtotal Closed-Tract Cholecystectomy'. J Clin Med. 2023; 12(3):1230.

Estes W.L. Acute gangrenous cholecystitis and the use of partial cholecystectomy in its treatment. Am J Surg 1938;40: 197e204.

Ben Zvi A., Dagan A., Freund M.R., et al. Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome. Am Surg. 2025; 91(6):1006-1009

Castro-LópezL.N., Cadena-Baquero J.C. Técnicas de Colecistectomía Laparoscó pica Subtotal como Estrategias de Manejo en Colecistectomías Difíciles. Ciencia Latina Revista Científica Multidisciplinar. 2023; 7, (6):5899-5923.

Álvarez-Sánchez G., Del Valle D.D., Maydón-González H.G., Pérez-Aguilar F. Colecistitis del remanente vesicular, una entidad en incremento: reporte de caso [Remnant gallbladder cholecystitis, an increasingly common entity: Case report]. Rev Med Inst Mex Seguro Soc. 2022; 60(3):350-355. 289

Strasberg S.M., Pucci M.J., Brunt L.M., Deziel D.J. Subtotal Cholecystectomy-"Fenestrating" vs "Reconstituting" Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. J Am Coll Surg. 2016; 222(1):89-96.

Motter S.B., de Figueiredo S.M.P., Marcolin P., et al. Fenestrating vs reconstituting laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis. Surg Endosc. 2024; 38(12):7475-7485.

Wong G.Y.M., Wadhawan H., Roth Cardoso V., et al; AMBROSE Collaborative. 30-day Morbidity and Mortality after Cholecystectomy for Benign Gallbladder Disease (AMBROSE): A Prospective, International Collaborative Cohort Study. Ann Surg. 2025; 281(2):312-321.

Gross A., Hong H., Hossain M.S., et al. Clinical and patient-reported outcomes following subtotal cholecystectomy: 10-year single-institution experience. Surgery. 2025; 179:108805.

Kumar S.S., Briggs E., Tannouri S., et al. What Happens After Discharge? A 2+ Year Follow-Up After Laparoscopic Subtotal Fenestrating and Reconstituting Cholecystectomy. Am Surg. 2024; 90(6):1800-1802.

Dhanasekara C.S., Shrestha K, Grossman H., et al. A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study. Surgery. 2024; 176(3):605-613.

Volkovetskii V., Lobanova O., Puzyr N., et al. Laparoscopic Common Bile Duct Exploration versus Endoscopic Retrograde Cholangiopancreatography for the Treatment of Difficult Common Bile Duct Stones: Pos-surgery Inflammation and Liver Function. J Gastrointest Surg. 2025: 102156.

Tringali A., Costa D., Ramai D. Endoscopic management of biliary leaks: Where are we now? World J Gastrointest Endosc. 2025; 17(7):107587.

Torres-Guaicha M.V., Tinoco-Ortiz T.L., Borja-Villacres S., et al. Transcystic biliary tract exploration during single-stage treatment for cholecystitis/symptomatic cholelithiasis plus choledocholithiasis using the SpyGlass system: a favorable therapeutic proposal. J Surg Case Rep. 2025; 2025(7):rjaf495.

Sönmez R.E., Özdemir T., Büyüker F., Alimoğlu O. Retroperitoneal duodenal perforation following biliary stent migration: A case report and review of conservative management. Turk J Surg. 2025, doi: 10.47717/turkjsurg.2025.2025-3-6.

Judy W., Gomez M.K., Liu Q., Neff L. ERCP first vs. surgery first: A comparative perspective in pediatric choledocholithiasis. Semin Pediatr Surg. 2025; 34:151501.

Padilla-Zegarra E.D., Memba-Ikuga R., Coronado-Llanos D., et al. Primary choledochorraphy after laparoscopic common bile duct exploration: comparative study of 3 different methods, safety, and efficacy. J Gastrointest Surg. 2025; 29(9):102122.

Alhamdani, A., Mahmud., S., Jameel., M. et al. Primary closure of choledocotomy after urgent laparoscopic exploration of the common bile duct. Surg Endosc. 2008; 22 , 2190–2195.

Wei-Jie Zhang, Gui-Fang Xu, Guo-Zhong Wu., et al. Laparoscopic Exploration of Common Bile Duct with Primary Closure Versus T-Tube Drainage: A Randomized Clinical Trial. Journal of Surgical Research. 2009: 157(1) e1-e5.

Yilmaz S., Ugurlu E.T., Gumusoglu A.Y., et al. Results of endoscopic retrograde cholangiopancreatography procedures at surgical clinics: A multicenter observational study in Türkiye. World J Gastrointest Surg. 2025; 17(5):104618.

Kawasaki Y., Ushio J., Kato H., et al. Usefulness of a One-step Semi-deployment Flushing and Stenting Technique in Endoscopic Transpapillary Gallbladder Drainage for Acute Cholecystitis (With Video). DEN Open. 2025; 6(1):e70163.

Nakahara K., Kobayashi S., Morimoto T., et al. Feasibility of endoscopic transpapillary gallbladder drainage for acute gangrenous cholecystitis in poor surgical candidates. Dig Endosc. 2025, doi: 10.1111/den.15050.

Nakabayashi R., Kamada H., Ono M., et al. Recurrence rate of cholecystitis after initial gallbladder stenting versus secondary gallbladder stenting: A propensity score matching study. DEN Open. 2024; 5(1):e70047.

Ciesielski W., Klimczak T., Durczyński A., et al. Endoscopic management of post-cholecystectomy cystic duct stump biliary leakage: Single-centre experience. Turk J Surg. 2025; 41(2):193-197.

Xu J.Q., Qu Y.F., Zhang Z.C., et al. Unsedated emergent ERCP is feasible and efficient for acute cholangitis in old patients over 80 years. Surg Endosc. 2025; 39(5):2847-2854

Downloads

Published

2025-08-20

How to Cite

Ramírez, A. G., Salgado, K. E. M., Padilla, R. I. G., Ríos, A. A., Domínguez, O. O., Cruz, B. S. M., … Sánchez, M. A. G. (2025). Subtotal Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography: A Colossal Synergy . British Journal of Healthcare and Medical Research, 12(04), 274–291. https://doi.org/10.14738/bjhr.1204.19237

Most read articles by the same author(s)

<< < 1 2 3 4 5