Abstract
Introduction
Cholecystectomy is considered the gold standard treatment for symptomatic gallstone disease. In certain cases, due to technical difficulties, a subtotal cholecystectomy may be performed. Between 1998 and 2015, a total of 1 423 080 laparoscopic cholecystectomies were performed. 10 162 patients who underwent completion cholecystectomy were identified and stratified by age (<50 vs. ≥50 years). This study examines outcomes and risk factors associated with completion cholecystectomy following partial (subtotal) cholecystectomy, with a focus on age and comorbidity burden.
Results
Older patients demonstrated significantly higher comorbidity burdens, as reflected by Charlson Comorbidity Index scores. Overall complication rates were substantial (26.3%), including gastrointestinal, infectious, and cardiopulmonary events. Mortality was 2.5% overall but markedly higher in patients aged ≥50 years (3.3% vs 0.6%). Length of stay was also longer in older patients.
Conclusions
Worse outcomes in older individuals correlated strongly with increased comorbidities rather than age alone. Completion cholecystectomy is frequently performed in complex surgical settings with distorted anatomy, contributing to higher complication rates. However, variability in outcomes across studies suggests that patient selection, operative approach, and baseline health status are key determinants. The study highlights the diagnostic challenge of post-subtotal cholecystectomy cholecystitis and underscores the importance of clinical vigilance. It concludes that careful preoperative risk stratification and patient selection are critical to improving outcomes, as procedural risk is closely tied to underlying health status and case complexity rather than the surgery itself.
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