Laparoscopic Reoperation for Postoperatively Diagnosed Gallbladder Cancer: Technical Options for Cystic Duct Management.

Abstract

Gallbladder cancer is a rare disease with poor prognosis, for which surgical resection is considered the only curative treatment.1 The widespread adoption of laparoscopic cholecystectomy for benign biliary diseases has led to an increased incidence of postoperatively diagnosed gallbladder cancer.2-5 Several studies have proposed that tumors exceeding stage T2 require additional resection.3,6,7 However, reoperation for postoperatively diagnosed gallbladder cancer is technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed.8,9 For such reasons, there are limited evidence regarding the safety and feasibility of laparoscopic reoperation and no clear indications for when to perform minimally invasive surgery. In this multimedia article, we present the laparoscopic reoperation techniques for postoperatively diagnosed gallbladder cancer. We focus specifically on various approaches to surgically manage the cystic duct stump, depending on the length of remnant stump, degree of surrounding fibrosis, and margin status. We represent three cases with different approaches. In the first case, a patient with a long remnant stump is managed with clip ligation and resection of the stump. Second, a patient with a short remnant stump and severe fibrosis is treated with stump excision and suture closure. Lastly, bile duct resection is performed for a patient with margin involvement during the initial operation. Various technical options exist to approach the remnant cystic duct stump during laparoscopic reoperation for postoperatively diagnosed gallbladder cancer.