Management of Gallbladder Remnant and the Cystic Duct Stump Calculi: A Retrospective Study

Abstract

Introduction: Gall bladder remnant and cystic duct stump calculi are reality in the era of Laparoscopic Cholecystectomy (LC). Despite a seemingly uneventful cholecystectomy, nearly 15% patients continue to have biliary symptoms; the post-cholecystectomy syndrome (PCS); which can manifest anytime from few days to several years after surgery This study aims to assess the safety and feasibility of Laparoscopic exploration of gallbladder remnant calculi leading to PCS. Materials and Methods: In this study, surgical explorations was done in 25 patients. The study considered parameters like the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 2 years and the data was retrospectively reviewed. Results: 25 patients diagnosed as symptomatic gallbladder remnant were identified. The most common symptoms at presentation included right upper quadrant pain (80%), Jaundice(12%) Cholangitis (4%). Symptoms began from 6 months to 25 years after index cholecystectomy. Diagnostic modalities utilized in the evaluation of these patients demonstrated that MRCP were effective with sensitivities of 100%. Of the 25 patients, 22 (88%) had completion LC . 3 patients (12%) were converted to open cholecystectomy because of dense adhesions and non-identification of structures laparoscopically. Conclusion: Diagnosis of residual GB stone is difficult. In expert hands and standard approach , completion LC of the gallbladder remnant can be performed within a reasonable operating time. There is low conversion rate with minimal post-operative complications and shorter hospital stay and minimal morbidity. Completion cholecystectomy can be challenging but is highly effective.