Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach.

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Advanced minimally invasive surgery (MIS) is not universally available in the Anglophone Caribbean, partly due to a shortage of trained laparoscopic surgeons. However, we have witnessed new opportunities for MIS advancement as we enter a period of rapid change in healthcare education. In this paper, we discuss the concept of distance mentoring and the opportunities to promote advanced MIS in the Caribbean. We believe that, if carefully and effectively administered, distance mentoring has the potential for widespread utility, but it requires a change in institutional and medical culture from direct personal training to one that also actively supports distance mentoring.

Percutaneous aspiration and drainage is increasingly being used in the diagnosis and management of surgical complications. The purpose of this study was to determine the natural history of right upper quadrant collections in cholecystectomy patients. Twenty‐seven consecutive patients undergoing cholecystectomy were examined ultrasonically. Collections in the subphrenic space, gallbladder fossa or wound were specifically sought. All patients had conventional T‐tube and wound drainage post‐operatively. Six collections were seen at the initial examination performed at a mean time of 6 days after surgery. Nineteen patients were re‐examined at a mean of 12.6 days post‐operatively and three of the collections seen initially had resolved, but 3 patients had developed new abnormalities. By 30 days, all collections had resolved except for one patient with a large subphrenic collection which required surgical drainage. It is concluded that collections are relatively common post‐cholecystectomy and most resolve spontaneously.