Remnant cholecystectomy: is it worthwhile doing?

Abstract

Background: Post cholecystectomy syndrome (PCS) is a significant problem following subtotal or total cholecystectomy. The underlying reason for PCS could be recurrent stone formation or infection of an obstructed remnant gallbladder. The aim of this study is to review the outcomes of remnant cholecystectomy (RC) from the tertiary hepatobiliary unit. Material and methods: We reviewed the outcomes of all patients that underwent RC between April 2005 and April 2017. Results: During the study period, 38 patients (26 females, median age 64.9 years (range: 24.9–83.7) underwent RC. The mean BMI was 30 (range: 19–42). The presenting symptoms were recurrent biliary colic: n = 17, 48%, cholecystitis: n = 10, 26.3%, cholangitis: n = 4, 10.5%, pancreatitis: n = 3, 7.8%, and non-specific abdominal pain: n = 4, 10.5%. In 21 (55.5%) patients the initial operation was performed laparoscopically. The index operation was subtotal cholecystectomy in 16 (42%), total cholecystectomy in 14 (36.8%), and details were unavailable in eight patients. The median time from initial operation to presentation was 1.22 years (range: 3 months to 30 years). Out of 38, 22 patients had laparoscopic RC. Three patients (8%) required biliary reconstruction. The overall post-operative morbidity was 18.4%. All except one patient was completely cured of their symptoms. Conclusions: Majority of patients following remnant cholecystectomy had symptomatic relief with no recurrence of symptoms. However, RC is associated with significant post-operative morbidity. Despite high morbidity, we believe that patients with persistent symptoms should be referred to hepatobiliary surgeons for further investigations and management.