Background Subtotal cholecystectomy (STC) is an accepted bailout strategy when the critical view of safety cannot be achieved. Whether intraoperative cholangiogram (IOC) findings should guide the choice between fenestrated and reconstituted STC remains unclear. This study evaluates the relationship between IOC results, STC technique, and postoperative outcomes over a 17-year period. Methods A retrospective cohort study was conducted across the Gold Coast Hospital and Health Service (2006–2023), including all adults undergoing STC. Variables included demographics, IOC findings (successful biliary opacification with no cystic duct or common bile duct calculi), STC technique, length of stay, readmission, cost, and complications (including bile leak and remnant cholecystitis). Results Of 10,964 cholecystectomies, 181 (1.65%) were STC. Reconstituted STC was performed in 87% (n=157) and fenestrated in 13% (n=24). A clear IOC was achieved in 25%; in 75%, IOC was unsuccessful or demonstrated cystic duct calculi. Clear IOC was not associated with reduced surgical complications compared with unsuccessful IOC or cystic duct calculi (OR 0.69, p=0.35). STC technique was also not associated with surgical complications (OR 0.48, p=0.10). No significant differences were observed in length of stay, readmission, or cost. Conclusion Neither IOC findings nor STC technique were associated with postoperative outcomes. Reconstituted STC was favoured at our institution, although both techniques appear safe. Prospective studies are required to determine whether intraoperative decision-making can be standardised by integrating cholangiographic findings with patient, anatomical, pathological, technical, and institutional factors to optimise technique selection and outcomes.