Subtotal Cholecystectomy Often Chosen Out of 'Habit or Fear'

Study finds SC use is concentrated among a small number of surgeons and hospitals, and it should be saved for clear-cut cases.

Mar. 11, 2026 at 10:48am

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A new study finds that subtotal cholecystectomy (SC), a procedure used as a bailout to prevent bile duct injuries during cholecystectomy, is often performed out of habit rather than clear necessity. The data suggests surgeon-related factors like experience, training, and institutional practices may influence the choice to perform SC, with a small number of surgeons accounting for the majority of SC cases. The study also found that SC was linked to a higher rate of postoperative reinterventions without a reduction in major bile duct injuries, which are rare but devastating.

Why it matters

The overuse of SC, a more complex procedure, can potentially harm patients by increasing complications without providing the intended benefit of preventing rare but serious bile duct injuries. The study calls for reserving SC only for unequivocal circumstances where the anatomy clearly dictates its necessity, rather than using it out of habit or fear.

The details

The retrospective study analyzed 17,299 cholecystectomies (CCs) performed by 111 surgeons across 12 hospitals. It found that 94 of the 157 SC cases (60%) were performed by just 8 surgeons, who collectively accounted for only 13% of all CCs. Additionally, 136 cases (87%) of SC were clustered in 3 hospitals, accounting for 31% of all CCs. Surgeons with more experience performing SC were significantly more likely to choose the procedure, while those who performed more CCs overall were less likely to opt for SC. The 30-day reintervention rate was significantly higher after SC compared to total CC (22.3% vs 5.1%), with no reduction in major bile duct injuries.

  • The study was published on March 11, 2026.

The players

Ramsey Michael Dallal, MD

The lead author of the study, affiliated with Jefferson Health-Einstein Bariatric Surgery in Elkins Park, Pennsylvania.

Christopher DuCoin, MD, MPH

The chief of the Division of Gastrointestinal Surgery at the University of South Florida in Tampa, Florida, who agrees with the study's conclusions.

Caitlin Hicks, MD, MS

A vascular surgeon at Johns Hopkins Medicine in Baltimore who researches quality and efficiency improvement in surgical procedures.

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What they’re saying

“By prioritizing avoidance of rare catastrophic injury over prevention of common morbidity, discretionary SC use risks perpetuating preventable complications.”

— Ramsey Michael Dallal, MD, Lead author of the study

“SC should be used only if there's 'significant inflammation or with a necrotic or ischemic gallbladder — if you can't do the proper dissection and a safe resection.'”

— Christopher DuCoin, MD, MPH, Chief of the Division of Gastrointestinal Surgery at the University of South Florida

“Sometimes the simplest thing to do is to let people know they're an outlier. We've seen a marked improvement in about 50% of physicians, simply by having awareness that what they're doing is not the norm.”

— Caitlin Hicks, MD, MS, Vascular surgeon at Johns Hopkins Medicine

What’s next

A larger study involving more surgeons will help clarify whether the behavior observed in this study is really outside the national norm or just outside the norm for this particular health system.

The takeaway

The overuse of subtotal cholecystectomy, a more complex procedure, can potentially harm patients by increasing complications without providing the intended benefit of preventing rare but serious bile duct injuries. The solution lies in reserving SC only for clear-cut cases where the anatomy dictates its necessity, rather than using it out of habit or fear.