Resection of gallbladder remnants after subtotal cholecystectomy: presentation and management

Concors, Seth J.; Kirkland, Matthew L.; Schuricht, Alan; Dempsey, Daniel T.; Morris, Jon B.; Vollmer, Charles M.; Drebin, J.A.; Lee, Major K.

doi:10.1016/j.hpb.2018.05.005

Cited by 26 publications

(32 citation statements)

References 10 publications

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“…11 With increasing availability and use of high resolution axial imaging modalities such as computed tomography and magnetic resonance imaging, it is increasingly recognized that these symptoms may be attributable to a remnant gallbladder. In two case series presented by Singh et al 7 and Concors et al, 8 diagnosis of the remnant gall bladder is often challenging. Furthermore, Singh et al identified that reporting and disclosure of a subtotal cholecystectomy was absent 71% of these cases.…”

Section: Discussionmentioning

confidence: 99%

“…The necessity of performing a cholangiogram is often debated, citing the need to perform a ductotomy as the source of bile duct injury. 8 However, the cholangiogram provides the benefit of confirming duct anatomy, including the length of the cystic duct, and identifying duct calculi, including the cystic duct. In this cohort, the trend of practice is to perform a cholangiogram as standard, demonstrated by the increasing rate of cholangiogram over the time period to 73%.…”

Section: Discussionmentioning

confidence: 99%

“…However, published case series of repeat cholecystectomies show an average 18-24 month time interval from first and second procedure. 7,8 Third, the data collected is limited by the completeness of the state-based records, where incomplete coding and recording (i.e. ICU stay) was unable to be tracked and collected.…”

Section: Discussionmentioning

confidence: 99%

“…Redo or completion cholecystectomy is a complex procedure, requiring division of adhesions, high likelihood of conversion to an open procedure, and increased risk of common bile duct injury. 7,8 In this review of state-based operative practices for cholecystectomy, the primary aim was to establish the incidence of redocholecystectomy and secondly identify risk factors that lead to subtotal cholecystectomy and completion surgery.…”

Section: Introductionmentioning

confidence: 99%

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The incidence of symptomatic remnant gall bladder: a population study

Bradshaw

Lau

Knowles

et al. 2020

ANZ Journal of Surgery

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Background: Subtotal cholecystectomy is utilized in conditions of high risk to critical structures, like the common bile duct. However, the remnant gall bladder may become symptomatic and require a completion cholecystectomy for treatment. This second procedure can itself be a risk to critical structures. To establish the incidence of redocholecystectomy and identify risk factors that lead to subtotal cholecystectomy and repeat operation in a review of state-based practices for cholecystectomy. Methods: A search of state coding records relating to cholecystectomy from 1998 to 2016. Patients who were coded for cholecystectomy-related procedures on different dates were identified. Patients who underwent the procedures within 6 months were excluded to avoid acute post-operative complications and gall bladder malignancy. Results: 210 719 cholecystectomies were performed. 1133 required repeat procedure. 616 were excluded, leaving 516 (0.25%) cholecystectomy patients requiring a second cholecystectomy. The subsequent operation was more likely to be an emergency procedure; involve transcystic bile duct exploration, adhesiolysis and require intensive care unit admission post-operatively. A repeat cholecystectomy was more likely to occur after having the primary procedure at a public hospital and when an intra-operative cholangiogram was not performed. Over the study period, the rate of repeat cholecystectomy increased from 0.02% to 0.6%. Incidentally, the rate of intra-operative cholangiogram during a primary cholecystectomy increased from 43% to 73%. Conclusions: Repeat cholecystectomy is an uncommon procedure. A second cholecystectomy is a more complex and likely to require intensive care unit support. Referral to a tertiary hepatobiliary unit is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The incidence of symptomatic remnant gall bladder: a population study

Bradshaw

Lau

Knowles

et al. 2020

ANZ Journal of Surgery

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“…The difficult gallbladder is a scenario caused by the inflammation, difficult exposure, Mirizzi syndrome, and cirrhosis of the liver. These are the situations where the surgeons often adapt the "bail-out" strategy such as subtotal cholecystectomy (3-8% of total cholecystectomies), so as to avoid iatrogenic complications to the bile duct and bowel [2]. On the contrary, the subtotal cholecystectomy does have the risk of increased bile leak from the stump and rarely a residual gallbladder (GB) [3].…”

Section: Introductionmentioning

confidence: 99%

Incidentally Detected Residual Gallbladder Calculi by Computed Tomography in Acute Pancreatitis. Case Report

Pandit

Das

Devkota

et al. 2020

SN Compr. Clin. Med.

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Calculi in the gallbladder or cystic duct remnant account for 0.3 to 2.5% of cases of post-cholecystectomy syndrome and must be considered in any patient who has undergone "difficult" cholecystectomy. We present an interesting case of a 62-year-old male, diagnosed to have moderately severe acute biliary pancreatitis, 4 years past laparoscopic converted to open cholecystectomy (LCOC). On evaluation with contrast computed tomography (CT) of the abdomen, changes of acute pancreatitis, along with a remnant gallbladder containing radiopaque calculi, were identified. The patient subsequently was managed successfully with completion cholecystectomy with common bile duct (CBD) exploration and T-tube drainage (for CBD calculi). Hence, differential diagnosis of residual gallbladder calculi (although rare) should be kept in a patient with acute biliary pancreatitis, following LCOC for a "difficult" gallbladder.

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Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

Acar

Sür

et al. 2020

J Hepato Biliary Pancreat

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Background Cholecystectomy is one of the most commonly performed surgical procedures. However, it may result in some unpleasant conditions such as bile duct injury (BDI), bile leak, and vessel injury. Subtotal cholecystectomy (SC), which has been introduced as an alternative method for reducing the complication rates, has been reported to have lower risk of BDI when compared to total cholecystectomy. This study aimed to evaluate the indications for SC, its early and late complications and their management, and the risk factors affecting the bile leak. Methods Fifty‐seven patients who underwent SC were included in the study, and their medical records were retrospectively reviewed. Results Thirty‐three patients were male (57.9%) and the mean age was 64.84 ± 11.35 (range: 29‐86). All patients had at least one episode of cholecystitis. Forty‐seven (82.5%) patients underwent surgery under emergency conditions. Postoperative bile leak/fistula, surgical site infection, and fluid collection were developed in 12 (21.1%), eight (14%), and six (10.5%) patients, respectively. Leaving the remnant tissue pouch open, presence of comorbidity and emergency operative condition were found to increase the risk of leak development (P < .001). During the average follow‐up of 49 months (range: 13‐98), symptomatic choledocholithiasis, symptomatic gallstones in the remnant tissue, and incisional hernia were detected within the first year of surgery in three (5.3%), four (7%), and seven (12.3%) patients, respectively. Conclusions Although SC is not an equivalent to total cholecystectomy, its vital benefit of lowering the risk of BDI should be considered in difficult cases.

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Resection of gallbladder remnants after subtotal cholecystectomy: presentation and management

Cited by 26 publications

References 10 publications

The incidence of symptomatic remnant gall bladder: a population study

The incidence of symptomatic remnant gall bladder: a population study

Incidentally Detected Residual Gallbladder Calculi by Computed Tomography in Acute Pancreatitis. Case Report

Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

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