Residual gallstone disease — Laparoscopic management

Kapoor

Ann Hepatobiliary Pancreat Surg

et al. 2018

Backgrounds/AimsA residual gallbladder (RGB) following a partial/subtotal cholecystectomy may cause symptoms that require its removal. We present our large study regarding the problem of a RGB over a 15 year period.MethodsThis study involved a retrospective analysis of patients managed for symptomatic RGB from January 2000 to December 2015.ResultsA RGB was observed in 93 patients, who had a median age of 45 (25–70) years, and were comprised of 69 (74.2%) females. The most common presentation was recurrence pain (n=64, 68.8%). Associated choledocholithiasis was present in 23 patients (24.7%). An ultrasonography (USG) failed to diagnose RGB calculi in 10 (11%) patients; whereas, magnetic resonance cholangio-pancreatography (MRCP) accurately diagnosed RGB calculi in all the cases except for 2 (4%) and, additionally, detected common bile duct (CBD) stones in 12 patients. Completion cholecystectomy was performed in all patients (open 45 [48.4%]; laparoscopic 48 [51.6%] and 19 [20.4%] patients required a conversion to open). The RGB pathology included stones in 90 (96.8%), Mirizzi's syndrome in 10 (10.8%) and an internal fistula in 9 (9.7%) patients. Additional procedures included CBD exploration (n=6); Choledocho-duodenostomy (n=4) and Roux-en-Y hepatico-jejunostomy (n=3). The mortality and morbidity were nil and 11% (all wound infection), respectively. Two patients developed incisional hernia during follow up. The mean follow up duration was 23.1 months (3–108) in 65 patients and the outcome was excellent and good in 97% of the patients.ConclusionsPost-cholecystectomy recurrent biliary colic should raise suspicion of RGB. MRCP is a useful investigation for the diagnosis and assessment of any associated problems and provides a roadmap for surgery. Laparoscopic completion cholecystectomy is feasible, but is technically difficult and has a high conversion rate.

Section: Introductionmentioning

confidence: 99%

Management of residual gall bladder: A 15-year experience from a north Indian tertiary care centre

Kapoor

Ann Hepatobiliary Pancreat Surg

et al. 2018

J Hepato Biliary Pancreat

“…These series include 3 to 11 patients with time spans ranging from 3 to 9 years. It has been shown both, in our series and the literature that patients present over a highly variable and wide‐ranging amount of time after initial cholecystectomy (range 1 month to 40 years) . CT, MRCP, ultrasound, and ERCP were used most often for diagnosis, with MRCP being the only modality used in all studies.…”

Section: Discussionmentioning

confidence: 79%

“…Residual gallstone disease occurs in only 0.18% of laparoscopic cholecystectomies; thus, it requires a high index of suspicion for diagnosis . In our study, four patients had an extensive extra‐biliary investigation with up to 3 years of pain and symptoms, prior to having a biliary workup and treatment.…”

Section: Discussionmentioning

confidence: 83%

“…In 1966, Bodvall published a series of 26 cases of symptomatic remnant gallbladders that were effectively treated by cholecystectomy . Subsequently, both open and laparoscopic resections have been described . The decision to choose one versus the other should be based on the laparoscopic capabilities of the institution with a low threshold for conversion to open surgery.…”

Section: Discussionmentioning

confidence: 99%

“…It results from incomplete resection, either unintended or deliberate, during cholecystectomy. Prior studies indicate its occurrence following both open and laparoscopic cholecystectomies without a difference in frequency between the two approaches . Symptoms of a remnant gallbladder may arise shortly after a surgery or many years later .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A diagnosis reconsidered: the symptomatic gallbladder remnant

Grossman

Johnston

Fowler

et al. 2019

Background Patients can present with symptomatic gallbladder disease after cholecystectomy due to a remnant gallbladder. This is a rare problem and challenging diagnosis with limited prior characterization; thus, we present a large series of patients with a gallbladder remnant. Methods A retrospective review was performed of all patients presenting with symptomatic gallbladder remnant at a tertiary care center from 2002 to 2016. Data on presenting symptoms, diagnostic tests, treatments, and follow-up were collected. Results Thirty-one patients diagnosed and treated for a symptomatic gallbladder remnant were identified. The most common presenting symptoms included right upper quadrant pain (87%) and nausea (55%). The median time from symptom presentation to definitive diagnosis was 60 days. Diagnostic modalities utilized in the evaluation of these patients demonstrated that endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were effective with sensitivities of 85% and 90%, respectively. Twenty-three (76.2%) patients underwent completion cholecystectomy, which proved to be definitive treatment. Additionally, eight (25.8%) patients were non-operative candidates and underwent endoscopic retrograde cholangiopancreatography and sphincterotomy, three of whom developed recurrent symptoms.Conclusion A symptomatic gallbladder remnant after cholecystectomy is infrequently seen; however, the diagnosis should be considered in patients with recurrent biliary symptoms after cholecystectomy. Completion cholecystectomy can be challenging but is highly effective for definitive treatment.

Robotics Computer Surgery

Robotic‐assisted completion cholecystectomy: A safe and effective approach to a challenging surgical scenario – A single center retrospective cohort study

Tschuor

Lyman

Passeri

et al. 2021

Background: Reoperation following a previous subtotal or aborted cholecystectomy presents a challenging surgical scenario that has traditionally required an open completion cholecystectomy. The aim of this study was to describe an institutional experience with a robotic-assisted approach to completion cholecystectomy. Methods:A database was retrospectively audited to identify all patients who underwent robotic-assisted cholecystectomy performed by two hepatopancreatobiliary surgeons at a single centre from 2010 to 2019. Results:Twenty six patients who underwent a robotic-assisted completion cholecystectomy were identified. Median operative time was 142 min (48-247 min) with a blood loss of 50 cc (0-500 cc). Minor complications (Clavien-Dindo ≤ II 90 days) occurred in three patients (11.5%) with no major complication or mortality reported. Median hospital length of stay was 1 day (0-6 days) with one patient readmitted. Conclusion:This study represents to our knowledge the largest series of roboticassisted completion cholecystectomies to date. The robotic approach appears to be a safe and effective procedure associated with a low morbidity and high success rate.