I read with great interest the article by Palanivelu and coworkers. Based on a large experience with 265 cirrhotic Child’s class A and B patients with symptomatic gallstones, the authors describe three technical variants of laparoscopic subtotal cholecystectomy (LSC). They report a remarkable 0.75% conversion rate and no mortality with this procedure. For patients in whom highrisk dissection of the Calot’s triangle is anticipated, they suggest LSC type II, which consists of leaving in situ part of the Hartmann’s pouch secured with a running Polygalactin suture. Bile leakage was the most common complication, occurring in 96 of 102 (94.1%) of these patients; the average duration of the leak was 4 days. Over the past 5 years, we have performed a type II LSC in patients with either severe cholecystitis (n 9) or liver cirrhosis (n 2), which represents 7% of cholecystectomies at our institution. The infundibulum was transected using a 30-mm Endo-GIA stapler, and the remaining gallbladder was removed in all patients using a conventional retrograde approach in 9, and a fundusfirst approach in 2. No major morbidity or bile leaks were recorded, and mean hospital stay was 2 days. One patient was readmitted 6 months later for a retained common bile duct stone and was successfully managed with endoscopic papillotomy. I agree with Palanivelu and colleagues that LSC is an excellent (and probably underused) technical option in patients with difficult gallbladders. Although subtotal cholecystectomy was first described more than 20 years ago, and has been successfully reproduced with laparoscopy, it is rarely mentioned in standard surgical textbooks as a viable alternative to cholecystostomy or to conversion to open cholecystectomy. When intraoperative findings indicate that LSC is appropriate and safer than attempting hazardous dissection in the “frozen” Calot’s triangle, use of the Endo-GIA stapler to transect the Hartmann’s pouch can speed the operation, avoid contamination of the operative field, and prevent bile leakage. REFERENCES