Outcomes of Fenestrating vs. Reconstituting Laparoscopic Subtotal Cholecystectomy: A Single-Center Retrospective Study
Bibliographic record
Abstract
Background: Laparoscopic subtotal cholecystectomy (LSTC), either fenestrating or reconstituting, offers potential benefits for the “difficult gallbladders” in terms of reduced bile duct injury (BDI) risk. Methods: This single-center retrospective cohort study analyzed data from patients who underwent reconstituting or fenestrating LSTC at a tertiary care center. We excluded patients who were converted to open cholecystectomy or had incomplete medical records. The data examined included demographic and clinical characteristics, preoperative assessments, operative details, and postoperative outcomes. No multivariable regression was performed because of the limited sample size. Results: The study included 46 patients (reconstituting: 20 patients; fenestrating: 26 patients). The severity of cholecystitis assessed by the Tokyo guidelines showed a higher proportion of Grade 2 severity in the reconstituting group than the fenestrating group (90% vs. 56.5%; p = 0.027). Both surgical techniques were similarly challenging and showed no significant differences in operative difficulty, operative duration, blood loss, or total hospital stay. Fenestrating procedures had non-significantly higher incidences of BDI (7.7% vs. 0%; p = 0.21), bile leakage (23.1% vs. 10%; p = 0.246), and intraoperative drain placement (88.5% vs. 75%; p = 0.232). Postoperative complications such as bile leaks were also comparable between the two techniques. Nevertheless, given the small sample, these observations are descriptive and should not be interpreted as evidence of comparability or superiority. Conclusions: Despite limitations, our analysis suggests that fenestrating and reconstituting approaches have comparable postoperative outcomes, although fenestrating procedures were associated with slight but non-significant increases in BDI and drain placement due to leaks. The choice of LSTC technique should depend on intraoperative findings, surgical expertise, and familiarity with each technique, but further studies are needed to obtain firm conclusions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".