Laparoscopic Reintervention for Residual Gallstone Disease

Abstract

Laparoscopic reintervention is being increasingly performed in patients who have previously undergone surgery for gallstone disease. A few patients with gallbladder remnants or a cystic duct stump with residual stones have recurrent symptoms of biliary disease. Patients with bile duct injuries were excluded from the study. We reviewed our experience in treating such patients over a 4-year period, January 1998 through December 2001. Five patients underwent laparoscopic reintervention after previous surgery for gallstone disease performed elsewhere during the period mentioned above. Of these 5 patients, 3 had impacted stones in gallbladder remnants (laparoscopic cholecystectomy, 2; open cholecystectomy, 1) and 2 had recurrent symptoms after cholecystolithotomy and tube cholecystostomy (conventional surgery) performed elsewhere. Laparoscopic excision of the gall bladder remnants was done in 3 patients and a formal laparoscopic cholecystectomy was done in 2 patients who had previously undergone cholecystolithotomy and tube cholecystostomy. The mean operating time was 42 minutes. No drainage was required postoperatively. All patients were symptom-free during a mean follow-up of 2.3 years (range, 7 months to 4 years). Reintervention may be required for patients with residual gallstones whose symptoms recur after gallbladder surgery such as cholecystectomy, subtotal cholecystectomy, and tube cholecystostomy. It is safe and feasible to remove the gallbladder or gallbladder remnants in such patients laparoscopically.

Residual gallstone disease — Laparoscopic management

“…The percentage of such patients is quite small and a high index of suspicion needs to be kept to reach a diagnosis. In 2003 we reported our initial experience of residual gallstone disease, which comprised 0.12% of the total volume of laparoscopic cholecystectomies (LCs) being performed at our center [6]. In the current expanded series, patients with residual gallstone disease comprised 0.18% of total volume of LCs performed.…”

“…The condition may arise as a result of inadequate dissection of cystic duct or a partial or ORIGINAL ARTICLE subtotal cholecystectomy. Patients with severe anatomical distortion, tissue friability or poor general condition are often managed by performing a salvage partial cholecystectomy or a cholecystostomy [6][7][8][9][10].…”

Laparoscopic Completion Cholecystectomy for Post Cholecystectomy Syndrome

“…1,10,16 The treatment of patients with gallbladder remnants who are symptomatic is excision of the remnant -the so-called "re-cholecystectomy", or "completion cholecystectomy". 1,10,11,[14][15][16][17] This can be performed either laparoscopically, 1,10,11,14,17 or by open technique, We preferred the laparoscopic approach despite anticipating dense adhesions and distorted anatomy in the region. Multiple dense adhesions can make revision surgery difficult.…”

Post Cholecystectomy Stump Calculus Cholecystitis with Completion Cholecystectomy –A Rare Case Report

“…ERCP is recommended only in situations where some intervention is contemplated. The treatment of patients with gallbladder remnants who are symptomatic is excision of the remnant -the so-called "re-cholecystectomy", or "completion cholecystectomy [18] . …”