Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):36-41. 10.14701/ahbps.2018.22.1.36.

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

• Singh A
• Kapoor A
• Singh RK
• Prakash A
• Behari A
• Kumar A
• Kapoor VK
• Saxena R

• KMID: 2409078
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.36

Abstract

BACKGROUNDS/AIMS
A 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.
METHODS
This study involved a retrospective analysis of patients managed for symptomatic RGB from January 2000 to December 2015.
RESULTS
A 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.
CONCLUSIONS
Post-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.

Keyword

Subtotal cholecystectomy; Residual gallbladder; Completion cholecystectomy; Laparoscopic cholecystectomy; Open cholecystectomy

MeSH Terms

Calculi
Cholecystectomy
Cholecystectomy, Laparoscopic
Choledocholithiasis
Colic
Common Bile Duct
Diagnosis
Female
Fistula
Follow-Up Studies
Gallbladder
Humans
Incisional Hernia
Mirizzi Syndrome
Mortality
Pathology
Recurrence
Retrospective Studies
Tertiary Healthcare*
Ultrasonography
Urinary Bladder*
Wounds and Injuries

Figure

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  Fig. 1 MRC reconstruction displays a residual gallbladder with a stone (marked with solid arrow), as well as choledocholithiasis (marked with hollow arrow).

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  Fig. 2 Intraoperative picture during laparoscopic completion cholecystectomy that displays residual gallbladder with a triangle of safety after Calot's triangle dissection.

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