Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):353-358. 10.14701/ahbps.2019.23.4.353.

Residual gall bladder: An emerging disease after safe cholecystectomy

• Gupta V
• Sharma AK
• Kumar P
• Gupta M
• Gulati A
• Sinha SK
• Kochhar R

• KMID: 2464324
• DOI: http://doi.org/10.14701/ahbps.2019.23.4.353

Abstract

BACKGROUNDS/AIMS
Residual gallbladder mucosa left after subtotal/partial cholecystectomy is prone to develop recurrent lithiasis and become symptomatic, which mandates surgical removal.
METHODS
We retrospectively evaluated the patients with residual gallbladder referred to us from January 2011 to December 2017. Based on MRCP we classified calot's anatomy to - type I where cystic duct was seen and type II where sessile GB stump was seen.
RESULTS
21 patients with median age 38 years and M:F::1:9.5, had undergone cholecystectomy (3 months-20 years) prior, presented with recurrent biliary pain. 3 had jaundice (CBD stone, Mirizzi and biliary stricture), 1 had pancreatitis and one had malignancy of the GB. Imaging revealed type I anatomy in 14 (67%) and type II in 7 (33%). All underwent completion cholecystectomy - open in 18 and laparoscopic in 3 (one converted to open). Additional procedure was required in 5 patients - CBD exploration in 2 (10%) and one each Hepatico-jejunostomy, extended cholecystectomy and splenectomy. Median hospital stay was 1 day. There was no mortality and 10% morbidity. One patient with malignancy died at 2 years, two died of unrelated cause, one developed incisional hernia and the remaining were well at a median follow up of 29 months.
CONCLUSIONS
Residual GB lithiasis should be suspected if there are recurrent symptoms after cholecystectomy. MRCP based proposed classification can guide the management strategy. Completion cholecystectomy is curative.

Keyword

Gall bladder; Cholecystectomy; Residual; Cystic duct; Remnant; Recurrent

MeSH Terms

Cholecystectomy*
Classification
Cystic Duct
Follow-Up Studies
Gallbladder
Humans
Incisional Hernia
Jaundice
Length of Stay
Lithiasis
Mortality
Mucous Membrane
Pancreatitis
Retrospective Studies
Splenectomy
Urinary Bladder*

Figure

• 

  Fig. 1 MRCP to show type I (left) and type II (right) Calot's anatomy. Note the presence of cystic duct in type IA. This patient had concomitant choledocholithiasis.

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  Fig. 2 Flow chart to show the algorithm of management.

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  Fig. 3 Operative picture to show (A) type I anatomy with gall bladder pouch, (B) Calot's triangle could be dissected and completion cholecystectomy was performed, (C) type II anatomy, small gall bladder with obliterated Calot's triangle (arrow), (D) small sized Gall bladder with a single large stone occupying the lumen.

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