The incidence of symptomatic remnant gall bladder: a population study

Abstract

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.

Intracholecystic papillary neoplasm associated with invasive carcinoma of the remnant gallbladder after subtotal cholecystectomy: a case report

“…Remnant cholecystectomy is an uncommon procedure, although several researchers have reported studies of this procedure [ 4 – 6 ]. In these reports, the major operative indications for the remnant gallbladder related to retained or recurrent biliary stones.…”

“…Remnant cholecystectomy is technically difficult because of adhesions, fibrosis, and anatomical change owing to the initial surgery [ 4 – 6 ]. In the present case, preoperative endoscopic retrograde cholangiopancreatography was useful to evaluate the status of the cystic duct, and extrahepatic bile duct resection was planned to be omitted.…”

“…When performing surgery for severe cholecystitis, subtotal cholecystectomy is an established bail-out procedure to avoid bile duct injury [ 3 ]. Few patients who undergo subtotal cholecystectomy require reoperation, including remnant cholecystectomy, which is an uncommon procedure [ 4 ]. The major reasons for reoperation for a remnant gallbladder are related to retained or recurrent biliary stones, and curative remnant cholecystectomy for remnant gallbladder cancer has been rarely reported [ 4 – 6 ].…”

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

“…Re‐operative biliary surgery including completion cholecystectomy has been performed frequently via an open operative approach 26 . While already established in urology, gynecology and colorectal surgery, the benefits offered by the robotic‐assisted approach are beginning to be realised and appreciated by HPB surgeons.…”

Necrotising fasciitis of abdominal wall following rupture of reconstituted remnant gallbladder

“…It is expected to increase due to advocacy of subtotal cholecystectomy in surgical training in difficult cases (eg, frozen Calot's triangle and cirrhotic liver with varices) to prevent biliary tree injury. [1][2][3] Its symptoms mimic those of biliary colic.…”