Quantifying patient-reported outcomes following subtotal cholecystectomy: A pilot cross-sectional study using a concise composite questionnaire

Abstract

Background: Little is known about patient-reported outcomes and health-related quality of life (QoL) following subtotal cholecystectomy (STC) for benign gallbladder disease. Aim: To conduct a cross-sectional, survey-based pilot study assessing patient-reported outcomes and health-related QoL among patients who underwent STC for complicated cholecystolithiasis. Methods: Forty-four eligible patients were randomly selected from a prospectively maintained list of STCs performed at a university hospital between 2011 and 2021. They were invited to participate in interviews using a five-section, composite, semi-structured questionnaire, which included the Gastrointestinal Quality of Life Index-10 (GIQLI-10), a modified version of the Short-Form Survey 36, and a subjective health self-assessment. Results: Nineteen patients (response rate: 43.2%) participated in the survey. STC was performed laparoscopically in 14 patients (73.7%). One patient (5.3%) required readmission. At the time of the interview, the mean age was 66.2 years (standard deviation [SD]: 16.95). Sixteen patients (84.2%) reported other medical conditions. The most common long-term symptoms were fatigue (n = 12; 63.2%), bloating (n = 10; 52.6%), and excessive flatulence (n = 10; 52.6%). The mean GIQLI-10 score was 32.5 out of 40 (SD: 6.0; 95% confidence interval [CI]: 29.6-35.4), with a median score of 35 (interquartile range (IQR): 9; 95% CI: 28-37), accounting for 87.5% of the maximum score. Fifteen patients (78.9%) reported their general health as good or very good. In 13 patients (68.4%), health remained unchanged or improved compared to one year earlier. The mean self-assessed health score was 74.1 (SD: 13.7; 95% CI: 67.5-80.7), with a median of 75 (IQR: 15; 95% CI: 65-80). Conclusion: These findings align with existing literature, showing generally positive patient-reported outcomes following STC. However, this study provides new quantitative details with greater granularity on overall health-related QoL and individual postoperative symptoms. Relevance for patients: The Short-Form Health Survey indicates that 8 out of 10 patients who underwent subtotal cholecystectomy reported their overall health as good or very good, despite experiencing some gastrointestinal symptoms. The information provided in this study can aid preoperative discussions and shared decision-making before cholecystectomy.

Keywords

Benign gallbladder disease / Subtotal cholecystectomy / Patient-reported symptoms / Patient-reported outcome measures / Quality of life

References

[1] Vohra RS, Pasquali S, Kirkham AJ, et al. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg. 2016; 103(12):1704-1715. doi: 10.1002/bjs.10287

[2] Talseth A, Edna TH, Hveem K, Lydersen S, Ness-Jensen E. Quality of life and psychological and gastrointestinal symptoms after cholecystectomy: a population-based cohort study. BMJ Open Gastroenterol. 2017; 4(1):e000128. doi: 10.1136/bmjgast-2016-000128

[3] Han IW, Lee HK, Park DJ, et al. Long-term patient-reported outcomes following laparoscopic cholecystectomy: a prospective multicenter observational study. Medicine. 2020; 99(35):e21683. doi: 10.1097/MD.0000000000021683

[4] Repo A, Eskelinen M, Saimanen I, et al. Patient-reported outcome measure (PROM) Rand-36-item health survey for gallstone disease patients five years following surgery: a prospective randomized study. In Vivo. 2024; 38(3):1213-1219. doi: 10.21873/invivo.13557

[5] Nzenwa IC, Mesri M, Lunevicius R. Risks associated with subtotal cholecystectomy and the factors influencing them: a systematic review and meta-analysis of 85 studies published between 1985 and 2020. Surgery. 2021; 170(4):1014-1023. doi: 10.1016/j.surg.2021.03.036

[6] Lunevicius R. Insights from global, national, and local studies of benign biliary disease for 2023. In: Gallstone Disease— Newer Insights and Current Trends. London, UK: IntechOpen; 2024. doi: 10.5772/intechopen.114994

[7] Lunevicius R, Nzenwa IC, Mesri M. A nationwide analysis of gallbladder surgery in England between 2000 and 2019. Surgery. 2022; 171(2):276-284. doi: 10.1016/j.surg.2021.10.025

[8] Dhanasekara CS, 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. doi: 10.1016/j.surg.2024.03.057

[9] Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for “difficult gallbladders”. JAMA Surg. 2015; 150(2):159-168. doi: 10.1001/jamasurg.2014.1219

[10] Van Dijk AH, Donkervoort SC, Lameris W, et al. Short- and long-term outcomes after a reconstituting and fenestrating subtotal cholecystectomy. J Am Coll Surg. 2017; 225(3):371-379. doi: 10.1016/j.jamcollsurg.2017.05.016

[11] Gross A, Hong H, Hossain MS, et al. Clinical and patient-reported outcomes following subtotal cholecystectomy: 10-year single-institution experience. Surgery. 2025; 179:108805. doi: 10.1016/j.surg.2024.07.060

[12] Daliya P, Gemmill EH, Lobo DN, Parsons SL. A systematic review of patient reported outcome measures (PROMs) and quality of life reporting in patients undergoing laparoscopic cholecystectomy. Hepatobiliary Surg Nutr. 2019; 8(3):228-245. doi: 10.21037/hbsn.2019.03.16

[13] Melly C, McGeehan G, O’Connor N, et al. Patient-reported outcome measures (PROMs) after laparoscopic cholecystectomy: systematic review. BJS Open. 2022; 6(3):zrac062. doi: 10.1093/bjsopen/zrac062

[14] Alexander HC, Nguyen CH, Moore MR, et al. Measurement of patient-reported outcomes after laparoscopic cholecystectomy: a systematic review. Surg Endosc. 2019; 33(7):2061-2071. doi: 10.1007/s00464-019-06745-7

[15] Vlessides M. Subtotal cholecystectomy appears safe and effective, but long-term data still needed. General Surgery News. 2025. Available from: https://www.generalsurgerynews.com/In-the-News/Surgical-Oncology/Article/03-25/Subtotal-Cholecystectomy-Long-Term-Outcomes/76255 [Last accessed on April 5, 2026].

[16] Lunevicius R, Haagsma JA. Subtotal cholecystectomy: results of a single-center, registry-based retrospective cohort study of 180 adults in 2011-2018. J Laparoendosc Adv Surg Tech A. 2021; 31(9):1019-1033. doi: 10.1089/lap.2020.0713

[17] Lunevicius R, Nzenwa IC. Multiple logistic regression model to predict bile leak associated with subtotal cholecystectomy. Surg Endosc. 2023; 37(7):5405-5413. doi: 10.1007/s00464-023-10049-2

[18] American Association for Public Opinion Research. Best Practices for Survey Research. AAPOR; 2022. Available from: https://aapor.org/standards-and-ethics/best-practices/ [Last accessed on May 22, 2024].

[19] Eypasch E.Gastrointestinal Quality of Life Index - 10 (GIQLI- 10). Mapi Research Trust; 2018. Available from:https://eprovide.mapi-trust.org/instruments/gastrointestinal-quality-of-life-index-10-items.

[20] Eypasch E, Williams JI, Wood-Dauphinee S, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg. 1995; 82(2):216-222. doi: 10.1002/bjs.1800820229

[21] Yu H, Chan EE, Lingam P, et al. Index admission laparoscopic cholecystectomy for acute cholecystitis restores Gastrointestinal Quality of Life Index (GIQLI) score. Ann Hepatobiliary Pancreat Surg. 2018; 22(1):58-65. doi: 10.14701/ahbps.2018.22.1.58

[22] Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30(6):473-483

[23] Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: scoping review. SAGE Open Med. 2016; 4:2050312116671725. doi: 10.1177/2050312116671725

[24] World Health Organisation. Constitution; 2026. Available from: https://www.who.int/about/governance/constitution [Last accessed on May 15, 2026].

[25] Singh R, Teel C, Sabus C, McGinnis P, Kluding P. Fatigue in type 2 diabetes: impact on quality of life and predictors. PLoS ONE. 2016; 11(11):e0165652. doi: 10.1371/journal.pone.0165652

[26] Siavash M, Tabbakhian M, Sabzghabaee AM, Razavi N. Severity of gastrointestinal side effects of metformin tablet compared to metformin capsule in type 2 diabetes mellitus patients. J Res Pharm Pract. 2017; 6(2):73-76. doi: 10.4103/jrpp.JRPP_17_2

[27] Carraro A, Mazloum DE, Bihl F. Health-related quality of life outcomes after cholecystectomy. World J Gastroenterol. 2011; 17(45):4945-4951. doi: 10.3748/wjg.v17.i45.4945

[28] 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. doi: 10.3390/jcm12031230

[29] Tay WM, Toh YJ, Shelat VG, et al. Subtotal cholecystectomy: early and long-term outcomes. Surg Endosc. 2020; 34(10):4536-4542. doi: 10.1007/s00464-019-07242-7

[30] Koo JGA, Chan YH, Shelat VG. Laparoscopic subtotal cholecystectomy: comparison of reconstituting and fenestrating techniques. Surg Endosc. 2021; 35(3):1014-1024. doi: 10.1007/s00464-020-08096-0

[31] Shi HY, Lee KT, Lee HH, et al. The minimal clinically important difference in the Gastrointestinal Quality-of-Life Index after cholecystectomy. Surg Endosc. 2009; 23(12):2708-2712. doi: 10.1007/s00464-009-0475-6