Special articleSubtotal Cholecystectomy–“Fenestrating” vs “Reconstituting” Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative ConditionsStrasberg, Steven M. MD, FACSa,*; Pucci, Michael J. MD, FACSc; Brunt, Michael L. MD, FACSb; Deziel, Daniel J. MD, FACSd Author Information aSection of Hepato-Pancreato-Biliary Surgery, Washington University in St Louis, St Louis, MO bSection of MIS Surgery, Washington University in St Louis, St Louis, MO cDivision of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA dDepartment of General Surgery, Rush University Medical Center, Chicago, IL Correspondence address: Steven M Strasberg, MD, FACS, Washington University in Saint Louis, 4990 Children’s Place, Suite 1160, Box 8109, Saint Louis, MO 63110. E-mail: [email protected] Submitted July 28, 2015; revised September 27, 2015; accepted September 28, 2015. Disclosure Information: Nothing to disclose. Disclosures outside the scope of this work: Dr Brunt receives research support grants from Gore and Karl Storz Endoscopy. This article is a work product of the SAGES Safe Cholecystectomy Task Force 2015. Journal of the American College of Surgeons: January 2016 - Volume 222 - Issue 1 - p 89-96 doi: 10.1016/j.jamcollsurg.2015.09.019 Buy Metrics Abstract Less than complete cholecystectomy has been advocated for difficult operative conditions for more than 100 years. These operations are called partial or subtotal cholecystectomy, but the terms are poorly defined and do not stipulate whether a remnant gallbladder is created. This article briefly reviews the history and development of the procedures and introduces new terms to clarify the field. The term partial is discarded, and subtotal cholecystectomies are divided into “fenestrating” and “reconstituting” types. Subtotal reconstituting cholecystectomy closes off the lower end of the gallbladder, reducing the incidence of postoperative fistula, but creates a remnant gallbladder, which may result in recurrence of symptomatic cholecystolithiasis. Subtotal fenestrating cholecystectomy does not occlude the gallbladder, but may suture the cystic duct internally. It has a higher incidence of postoperative biliary fistula, but does not appear to be associated with recurrent cholecystolithiasis. Laparoscopic subtotal cholecystectomy has advantages but may require advanced laparoscopic skills. © 2016 by Lippincott Williams & Wilkins, Inc.