Abstract
Background
A few patients who continue to suffer antecedent symptoms following laparoscopic cholecystectomy (LC) may harbor residual gallstones. The incidence of residual gallstones following cholecystectomy is <2.5%. Many of these patients require a completion cholecystectomy to ameliorate their symptoms.
Materials and methods
We reviewed our experience of laparoscopic re-intervention for residual gallstones over a period of 10 years from January 1998 to December 2007. Twenty six patients underwent Laparoscopic completion cholecystectomy (LCC) for residual gallstone disease. Twelve patients had a previous LC (2 patients — subtotal cholecystectomy) and 9 patients had a previous open cholecystectomy (7 patients — subtotal cholecystectomy). Five patients had previously undergone a cholecystostomy. Diagnostic investigations included abdominal ultrasound, endoscopic ultrasound (EUS), magnetic resonance cholangio-pancreatography (MRCP) and endoscopic retrograde cholangio-pancreatography (ERCP).
Results
Findings included a remnant gallbladder in 3 patients, long cystic duct stump with impacted stone in 18 patients and a contracted gallbladder in 5 patients. All procedures were successfully completed laparoscopically. The mean operative time was 62 minutes and mean blood loss 50cc. Ten patient required abdominal drains postoperatively. Two patients had bilious drainage lasting 9 days and 11 days respectively. One patient died a week following surgery of acute myocardial infarction. Another patient died 6 months later of unrelated causes. The remaining patients have remained symptom free at a mean follow up of 3.2 years (range 7 months to 9 years).
Conclusion
The possibility of residual gallstones increases with subtotal cholecystectomy and inadequate dissection of the Calot’s triangle in the presence of acute inflammation. Laparoscopic re-intervention for treating residual gallstone disease is feasible and can be safely performed in centers of expertise.
References
Venu RP, Greene JE (1995) Postcholecystectomy syndrome; in Yamada T (Ed.): Textbook of Gastroenterology, 2 edition, Philadelphia, Lipincott 2265–2277
Moody FG (1987) Postcholecystectomy syndromes. Ann Surg 19:205–220
Schofer JM (2008) Biliary causes of postcholecystectomy syndrome. J Emerg Med. Aug 22.
Lum YW, House MG, Hayanga AJ, Schweitzer MJ (2006) Postcholecystectomy syndrome in the laparoscopic era. Laparoendosc Adv Surg Tech A 16(5):482–485
Demetriades H, Pramateftakis MG, Kanellos I, Angelopoulos S, Mantzoros I, Betsis D (2008) Retained gallbladder remnant after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 18(2):276–279
Chowbey PK, Bandyopadhyay SK, et al. (2003) Laparoscopic reintervention for residual gallstone disease. Surg Lap Endosc Percut Tech 13(1):31–35
Philips JA, Lawes DA, Cook AJ et al. (2008) The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc 22(7):1697–700
Michalowski K, Bornman PC, Krige JE, Gallagher PJ, Terblanche (1998) J Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85(7):904–906
Spira RM, Nissan A, Zamir O, Cohen T, Fields SI, Freund HR (2002) Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis Am J Surg 183(1):62–66
Kuster GG, Domagk D (1996) Laparoscopic cholecystostomy with delayed cholecystectomy as an alternative to conversion to open procedure. Surg Endosc 10(4):426–428
Bradley KM, Dempsey DT (2002) Laparoscopic tube cholecystostomy: Still useful in the management of complicated acute cholecystitis. J Laparoendosc Adv Surg Tech A 12(3): 187–191
Berber E, Engle KL, String A, Garland AM, Chang G, Macho J, Pearl JM, Siperstein AE (2000) Selective use of tube cholecystostomy with interval laparoscopic cholecystectomy in acute cholecystitis. Arch Surg 135(3):341–346
Ji W, Li LT, Li JS (2006) Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis. Hepatobiliary Pancreat Dis Int 5(4):584–589
Sinha I, Smith ML, Safranek P, Dehn T, Booth M (2008) Laparoscopic subtotal cholecystectomy without cystic duct ligation. Br J Surg 95(4):534
Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M, Yamamoto Y, Sugishita H, Kawachi K (2008) Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc 22(12):2720–2723
Chowbey PK, Sharma A, Khullar R, et al. (2000) Laparoscopic subtotal cholecystectomy: A review of 56 procedures. J Laparoendosc Adv Surg Tech 10:31–34
Jenkins PJ, Paterson HM, Parks RW, Garden OJ (2008) Open cholecystectomy in the laparoscopic era. Br J Surg 95(4):531
Li LB, Cai XJ, Mou YP, Wei Q (2008) Reoperation of biliary tract by laparoscopy: Experiences with 39 cases. World J Gastroenterol 21;14(19):3081–3084
Mishra G, Conway JD (2009) Endoscopic ultrasound in the evaluation of radiologic abnormalities of the liver and biliary tree. Curr Gastroenterol Rep 11(2):150–154
Scheiman JM, Carlos RC, Barnett JL, Elta GH, Nostrant TT, et al. (2001) Can Endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol 96(10):2900–2904
Monalisa F, Saftoiu A, et al. (2009) Post cholecystectomy syndrome - An algorithmic approach. J Gastrointestin Liver diseases. 18(1):67–71
Matsubayashi H, Fukutomi A, Kanemoto H, Maeda A, Matsunaga K, et al. (2009) Risk of pancreatitis after endoscopic retrograde cholangiopancreatography and endoscopic biliary drainage. HPB (Oxford). 11(3): 222–228
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Chowbey, P., Soni, V., Sharma, A. et al. Residual gallstone disease — Laparoscopic management. Indian J Surg 72, 220–225 (2010). https://doi.org/10.1007/s12262-010-0058-8
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DOI: https://doi.org/10.1007/s12262-010-0058-8