Gallbladder Remnant Research Articles

Surgical Management of Cystic Duct Stump Stone or Gall Bladder Remnant Stone.

Retained calculi in the cystic duct or gall bladder remnant can present as a post-cholecystectomy problem. Increased suspicion is necessary to diagnose this condition in a symptomatic post-cholecystectomy patient. Ultrasonography usually detects this condition, but magnetic resonance cholangiopancreatography is the test of choice for diagnosis as well as for surgical planning. Laparoscopic re-excision of the stump in most cases is feasible and safe. It is increasingly becoming the treatment of choice.

Closure of the cystic duct orifice in laparoscopic subtotal cholecystectomy for severe cholecystitis

Laparoscopic subtotal cholecystectomy (LSC) has been recognized as an alternative to conversion to laparotomy for severe cholecystitis. However, it may be associated with an increased risk of recurrent stones in the gallbladder remnant. The objective of this study was to evaluate the safety and feasibility of the complete removal of the gallbladder cavity in LSC for severe cholecystitis using the cystic duct orifice suturing (CDOS) technique. In a consecutive series of 412 laparoscopic cholecystectomies that were performed from January 2015 to June 2017, 12 patients who underwent LSC with CDOS were enrolled in this retrospective study. In this procedure, Hartmann's pouch was carefully identified, and the infundibulum-cystic duct junction was transected while the posterior wall adherent to Calot's triangle was left behind. The clinical records, including the operative records and outcomes, were analyzed. The median operating time and blood loss were 158 min and 20 mL, respectively. In all cases, LSC with CDOS was completed without conversion to open surgery. No injuries to the bile duct or vessels were experienced. The median postoperative hospital stay was 6 days. Postoperative complications occurred in two patients (bile leakage, n = 1: common bile duct stones, n = 1) and were successfully treated by endoscopic management. A gallbladder remnant was not delineated by postoperative imaging in any of the cases. These results suggest that LSC with CDOS is a promising approach that can avoid dissection of Calot's triangle and achieve the complete removal of the gallbladder cavity in patients with severe cholecystitis.

Got a Leak! Letʼs Glue It

Introduction: The procedure of choice for management of acute cholecystitis is laparoscopic cholecystectomy (LC). LC has it's distinct advantages; however, post-operative refractory bile leaks present a significant therapeutic challenge. Herein, we report a case of endoscopic occlusion of high grade bile leak from the gall bladder remnant that failed all standard endoscopic maneuvers via the use of human pooled plasma fibrinogen and thrombin (HPF) (Tissel, Baxter, CA) as a sealant. Case: A 65-year-old male presented with abdominal pain and was found to have CT and HIDA scan findings consistent with acute cholecystitis. Laparoscopic evaluation revealed severely inflamed and gangrenous gall bladder, hence he underwent an open subtotal cholecystectomy. Post operatively, patient had increased bilious output from the JP drain, therefore, a CT scan abdomen was done which revealed a biloma in the gall bladder fossa. ERCP revealed a high grade bile leak from the gall bladder remnant and suggestion of ampullary stenosis. Biliary sphincterotomy was performed and a 10 Fr x 5 cm plastic stent was placed in the common bile duct (CBD). Due to persistent high output from the JP drain, a repeat ERCP was done 4 weeks later; occlusion cholangiogram revealed low grade bile leak from the gall bladder remnant. Balloon sweep with clearance of biliary sludge was performed and the plastic stent was interchanged with a 10 mm x 6 cm fully covered self-expanding metal stent (FC-SEMS). Six weeks after placement of the FC-SEMS, patient still had persistent bilious drainage from the JP drain therefore a third ERCP was done. The previously placed biliary stent was removed and cholangiogram revealed a high grade bile leak. No filing defects or stricture were noted in the CBD. The CBD was dilated to 10 mm and the cystic duct stump was successfully cannulated and injected with 3 ml of HPF for the purpose of sealing the leak. Repeat cholangiogram demonstrated no leak. A 10 mm x 80 mm FC-SEMS was placed in the common bile duct. Follow up ERCP 3 months later revealed normal cholangiogram with no evidence of ongoing bile leak and the FC-SEMS was removed. Discussion: To our knowledge this a first report demonstrating use of HPF endoscopically for successful management of refractory bile leak. HPF should note be injected into vascular structures due to concern for vascular thrombosis. Further studies and reports are needed to evaluate the safety and efficacy of this technique.

Laparoscopic Excision of Remnant Gallbladder after Subtotal Cholecystectomy

Laparoscopic Excision of Remnant Gallbladder after Subtotal Cholecystectomy

Clinical features and treatment of residual gallbladder lesions after cholecystectomy

Objective To investigate the clinical features and treatment of residual gallbladder lesions after cholecystectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 83 patients with residual gallbladder lesions after cholecystectomy who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between January 2009 and April 2016 were collected. Among the 83 patients, 74 had residual gallbladder (41 combined with bile duct stones and 33 with simple residual gallbladder) and 9 had simple residual bile duct stones. Patients received laboratory and imaging examinations, and then selected suitable surgery according to residual lesions. Observation indicators included: (1) clinical features: medical history, clinical manifestation, features of laboratory and imaging examinations; (2) surgical and postoperative situations: surgical procedure, operation time, volume of intraoperative blood loss, time of drainage-tube removal, postoperative complications and duration of postoperative hospital stay; (3) postoperative pathological examination; (4) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and recurrence of lesions using abdomen color Doppler ultrasound up to October 2016. Measurement data with normal distribution were represented as ±s. Results (1) Clinical features: ① medical history: all the 83 patients had histories of cholecystectomy, including 57 with emergency operation and 26 with selective operation. ② Clinical manifestation: initial clinical manifestation occurred at 1-324 months postoperatively, with an average time of 96 months. Of 83 patients, 49 had right upper abdominal colic associated with right shoulder or back rediating pain, fever, nausea and vomiting, 24 had jaundice as the main symptoms, 8 had gradually worse conditions, with right upper quadrant abdominal pain, chills and fever associated with jaundice in the advanced stage and 2 had abdominal discomfort associated with incomplete intestinal obstruction. ③ Laboratory examination: elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels were detected in 48 patients, elevated total bilirubin (TBil) level in 28 patients and elevated serum and urinary amylase level in 4 patients, respectively. ④ Imaging examination: of 83 patients, 77 had positive results of magnetic resonanced cholangio-pancreatography (MRCP), 43 had positive results of abdominal color Doppler ultrasound and 39 (4 combined with pancreatitis) had positive results of abdominal computed tomography (CT). (2) Surgical and postoperative situations: all the 83 patients underwent surgery. Of 74 patients with residual gallbladder, 72 underwent residual gallbladder resection (of 41 combined with bile duct stones, 35 undergoing residual gallbladder resection + bill duct exploration and removing the stone + T-tube drainage, 6 initially undergoing endoscopic sphincterotomy for removing bile duct stones and then residual gallbladder resection and 31 undergoing simple residual gallbladder resection), 1 combined with residual gallbladder cancer underwent residual gallbladder resection + common bile duct resection + hepatic duct-jejunum internal drainage and 1 combined with residual gallbladder cancer and common bile duct space-occupying lesion underwent palliative biliary-enterostomy. Nine patients with simple residual bile duct stones underwent endoscopic sphincterotomy for removing bile duct stones. Operation time, volume of intraoperative blood loss, time of drainage-tube removal and duration of postoperative hospital stay were (92±39)minutes, (63±12)mL, (5±4)days and (9±5)days in 74 patients with residual gallbladder, respectively. There was no severe postoperative complication. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were (57±33)minutes, (25±9)mL and (5±3)days in 9 patients with simple residual bile duct stones, respectively. No severe complication was occurred in 9 patients. (3) Postoperative pathological examination: the length of residual cystic duct in 74 patients with residual gallbladder was (2.8±1.0)cm, combining with stones. Of 74 patients, simple hyperplasia of residual gallbladder were detected in 54 patients, dysplasia in 14 patients, tumor-like hyperplasia and benign tumor in 4 patients and adenocarcinoma in 2 patients. (4) Follow-up situation: all the 83 patients were followed up for 6-71 months, with a median time of 33 months. Eighty-one patients were healthy survival, without recurrence of lesions. One patient had recurrence of bile duct stones at 34 months postoperatively, and then was cured by choledochojejunostomy, without recurrence up to the end of follow-up. One patient with residual gallbladder cancer complicated with common bile duct space-occupying lesion died at 9 months postoperatively. Conclusions Patients have recurrent right upper abdominal colic associated with right shoulder or back rediating pain, fever and jaundice after cholecystectomy, and lesions of residual gallbladder or bile duct stones should be considered. Reoperation is safe and feasible for patients, with a good clinical outcome. Key words: Remnant gallbladder; Cholelithiasis; Cholecystectomy

Damage-control laparoscopic partial cholecystectomy with an endoscopic linear stapler.

Several damage-control procedures have been described in the literature in case of severe Calot's triangle inflammation and fibrosis. In this report, we describe patients who underwent laparoscopic partial cholecystectomy using an endoscopic linear stapler. Five patients with acute cholecystitis underwent laparoscopic partial cholecystectomy in our clinic between January - December 2011. All patients had severe fibrosis and inflammation of Calot's triangle. The anterior and posterior walls of the gallbladder were totally resected if possible. The gallbladder was transected at its neck or Hartmann's pouch, leaving a remnant gallbladder pouch behind. Five patients had laparoscopic partial cholecystectomy with an endoscopic linear stapler. The main symptom of all patients on admission to the emergency room was abdominal pain. The mean time for the surgical procedure was 140 minutes (range, 120-180 minutes). Inflammation and fibrosis of Calot's triangle was detected in all patients during surgery and a phlegmonous gallbladder was detected in one patient. Surgical drains were used in all patients and no biliary leakage was detected. Remnant common bile duct calculi were detected in one patient and this patient underwent endoscopic retrograde cholangiopancreatography one month after surgery. When a reliable view of Calot's triangle cannot be obtained due to severe inflammation and fibrosis during laparoscopy, laparoscopic partial cholecystectomy seems to be a safe and feasible alternative to open surgery with an acceptable morbidity rate.

Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Çetin D, Aday U, Çiyiltepe H, Gündeş E, Bozdağ E, Uzun O. Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome. Archives of Medical Science - Civilization Diseases. 2017;2(1):27-28. doi:10.5114/amscd.2017.66385. APA Çetin, D., Aday, U., Çiyiltepe, H., Gündeş, E., Bozdağ, E., & Uzun, O. (2017). Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome. Archives of Medical Science - Civilization Diseases, 2(1), 27-28. https://doi.org/10.5114/amscd.2017.66385 Chicago Çetin, Durmuş Ali, Ulaş Aday, Hüseyin Çiyiltepe, Ebubekir Gündeş, Emre Bozdağ, and Orhan Uzun. 2017. "Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome". Archives of Medical Science - Civilization Diseases 2 (1): 27-28. doi:10.5114/amscd.2017.66385. Harvard Çetin, D., Aday, U., Çiyiltepe, H., Gündeş, E., Bozdağ, E., and Uzun, O. (2017). Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome. Archives of Medical Science - Civilization Diseases, 2(1), pp.27-28. https://doi.org/10.5114/amscd.2017.66385 MLA Çetin, Durmuş Ali et al. "Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome." Archives of Medical Science - Civilization Diseases, vol. 2, no. 1, 2017, pp. 27-28. doi:10.5114/amscd.2017.66385. Vancouver Çetin D, Aday U, Çiyiltepe H, Gündeş E, Bozdağ E, Uzun O. Remnant gallbladder stones: a rare cause of post-cholecystectomy syndrome. Archives of Medical Science - Civilization Diseases. 2017;2(1):27-28. doi:10.5114/amscd.2017.66385.

Mirror Mirror on the Wall: ERCP in a Patient with Situs Inversus Totalis

Situs inversus totalis is an extremely rare autosomal recessive disorder occurring in 0.01% of the population. The reversal of visceral organs poses technical difficulties for therapeutic intervention during endoscopic retrograde cholangiopancreatography (ERCP). We describe a unique case of a patient with situs inversus who underwent therapeutic ERCP for management of choledocholithiasis. A 37-year-old woman with a history of situs inversus totalis, complex congenital cyanotic heart disease, polysplenia and laparoscopic partial cholecystectomy performed 10 years prior, presented with post-prandial right upper quadrant pain and nausea. She had elevated bilirubin, and computed tomography (CT) scan showed cholelithiasis in the remnant gallbladder. An endoscopic retrograde cholangiopancreatography (ERCP) was performed for possible choledocholithiasis. Patient was placed in the left oblique position. There was altered anatomy of the gastric curvature and the ampulla was located in the 2 o'clock position. Biliary access was achieved by keeping the scope in the long position, rotating the duodenoscope 180o, and rotating the sphincterotome to the right side. Cholangiogram showed a mirror image of the transposed biliary tree and remnant gallbladder with filling defects consistent with cholelithiasis. Biliary sphincterotomy was performed and balloon sweep showed biliary stone fragments, consistent with choledocholithiasis. She subsequently underwent cholecystectomy for removal of the remnant gallbladder.Figure 1Figure 2Situs inversus is a rare benign congenital anomaly that may pose difficulty during ERCP. Different techniques have been used for biliary access in patients with situs inversus such as, a “mirror image” ERCP technique with the endoscopic maneuvers performed in an inverse fashion, or positioning the patient lying prone on her right side. In our case biliary access is easily achievable in patient s with situs inversus by keeping the patient in the left oblique position, along with maneuvering the duodenoscope and sphincterotome towards the inversed position of the ampulla.

Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique.

Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II. Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient. Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5±65.5min. The stone clearance rate was 100%. The postoperative length of hospital stay was 5.1±2.2days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2%) and one superficial wound infection (9.1%). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1months. LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.

Reformed gallbladder after subtotal cholecystectomy: two case reports and literature review

Introduction: Subtotal cholecystectomy is a procedure reserved for severe cholecystitis where the patient conditions are unstable and it is not possible to identify the structures of the Calot triangle. It is considered a safe procedure, however occasional reoperation may be necessary. Objective: The goal of the study is report two cases of reoperation for reformed gallbladder after subtotal cholecystectomy in a single center and to conduct a literature review on reformed gallbladders after incomplete gallbladder removal. Method: A literature search of PubMed and EMBASE (1985 – February 2015) was conducted. Search criteria included “reformed gallbladder” “subtotal cholecystectomy” “partial cholecystectomy” “reoperation” “remnant gallbladder” “retained gallbladder” using the Boolean operators “AND” “OR”, limited to title or abstract with publication in the English. The bibliographies of the recovered articles were examined to find supplementary references of data. Results: Literature review included twenty-one publications, excluding five articles that did not mention reoperation for remnant gallbladder. Repeated articles describing the same case were excluded, the one containing the most complete information was analysed. We found 38 cases of “recholecystectomy” in the literature. Most of them (30 cases) were reoperated laparoscopically. The interval between first and second surgery ranged from 2 weeks to 32 years. Indications for reoperation were more frequently right upper quadrant pain. Conclusion: Literature with reference to subtotal cholecystectomy and reformed gallbladder is scarce. This surgery became an important technique used mainly for cases of severe cholecystitis. Caution is necessary since diagnosis for reformed gallbladder is unusual and the reoperation increases morbidity rates.

Laparoscopic completion cholecystectomy for remnant gallbladder following previous incomplete cholecystectomy: a case series

Laparoscopic completion cholecystectomy for remnant gallbladder following previous incomplete cholecystectomy: a case series

The Laparoscopic Re-Exploration in the Management of the Gallbladder Remnant and the Cystic Duct Stump Calculi

The gallbladder remnant and the cystic duct stump calculi are uncommon causes of post-cholecystectomy syndrome. Re-exploration is usually needed in the cases where symptom persists. Very few case series and reports are available regarding laparoscopic re-exploration. To assess the safety and feasibility of Laparoscopic re-exploration in the cases of gallbladder remnant and cystic duct stump calculi leading to post cholecystectomy syndromes. In this study, laparoscopic re-explorations was done in 22 patients in which 17 patients had gallbladder remnant calculi and 5 had cystic duct stump calculi. 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 15 years and the data was retrospectively reviewed. The median operating time was 83 minutes (range 51 to 134 minutes). Only one patient had conversion to open surgery. In postoperative period two patients had bile leak. They were managed conservatively and leak subsided in 8 and 11 days respectively. One patient had postoperative bleeding not requiring blood transfusion. There was no major complication requiring further intervention and no mortality. Patients were discharged on median day 4 (range 2-11) after the surgery. Patients were followed up every 3 months for one year. However, out of these three patients did not turn up for follow-up. In expert hands laparoscopic re-exploration of the gallbladder remnant/cystic duct stump calculi can be performed within a reasonable operating time. The conversion to conventional re-exploration rate was very low with minimal post-operative complications and shorter hospital stay.

Subtotal Cholecystectomy–“Fenestrating” vs “Reconstituting” Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions

Less than complete cholecystectomy has been advocated for difficult operative conditions for more than 100 years. These operations are called partial or subtotal cholecystectomy, but the terms are poorly defined and do not stipulate whether a remnant gallbladder is created. This article briefly reviews the history and development of the procedures and introduces new terms to clarify the field. The term partial is discarded, and subtotal cholecystectomies are divided into "fenestrating" and "reconstituting" types. Subtotal reconstituting cholecystectomy closes off the lower end of the gallbladder, reducing the incidence of postoperative fistula, but creates a remnant gallbladder, which may result in recurrence of symptomatic cholecystolithiasis. Subtotal fenestrating cholecystectomy does not occlude the gallbladder, but may suture the cystic duct internally. It has a higher incidence of postoperative biliary fistula, but does not appear to be associated with recurrent cholecystolithiasis. Laparoscopic subtotal cholecystectomy has advantages but may require advanced laparoscopic skills.

Preoperative Prediction of Laparoscopic Subtotal Cholecystectomy for Severe Cholecystitis

Introduction: Laparoscopic cholecystectomy for cholecystitis with severe inflammation and/or fibrosis in Calot's triangle is associated with bile duct injury and a high conversion rate. However, some studies have reported the usefulness of laparoscopic subtotal cholecystectomy (LSC) in such condition, although laparoscopic experience and skills are demanded. In this study, we displayed our LSC, and developed a predictive score for LSC to avoid risky dissection on Calot's and conversion to open. Methods: Our LSC consists of transection at the gallbladder neck followed by closure of the remnant gallbladder stump, without dissection of Calot's. Between January 2004 and December 2013, 110 patients underwent LSC due to severe inflammation or fibrosis in Calot's triangle, and 1466 underwent conventional laparoscopic cholecystectomy (LC). Their clinical records were analyzed for their effect on the ratio of LSC to LC (LSC rates) by multivariate analysis, and a constant and coefficients for these independent variables were calculated and formed the predictive score. Results: All of 110 LSC were completed without conversion to open procedure. Postoperative complications were recorded in 11 of 110 patients (10.0%), of which all were treated conservatively. Bile duct injury and mortality were not observed in LSC series. Among the clinical characteristics of all patients, significant association with LSC rates were found in 5 variables, that is, preoperative CRP elevation (Symbol5), wall thickened Gallbladder, atrophic Gallbladder, pericholecystic abscess, and structure of extra hepatic bile duct. Mean of the predictive score in LSC was 8.2, and ideal cut-off point for score was 8; specificity and sensitivity toward LSC was 76.0% and 77.0%, respectively.SymbolConclusion: LSC for severe cholecystitis is safe and feasible. An experienced surgeon should operate on the patients who have the predictive score over 8, making a decision to LSC appropriately.

Successful removal of a foreign body from a gallbladder remnant by using a new single-operator digital cholangioscope

Successful removal of a foreign body from a gallbladder remnant by using a new single-operator digital cholangioscope

Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination

Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking. To investigate the DBR rate in patients with recurrent CBDS after ERCP. A prospective case-control study. A tertiary center. During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded. Standard barium meal examination, MRCP, and enhanced abdominal CT. DBR. Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences. Small sample size. DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. ( NCT02329977.)

Residual gallbladder stones after cholecystectomy: A literature review.

BACKGROUND:Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy.MATERIALS AND METHODS:Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up.RESULTS:Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct.CONCLUSION:Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones.

Subtotal cholecystectomy in difficult laparoscopic cholecystectomies: is it safe?

Purpose Laparoscopic cholecystectomy is now accepted as the 'gold standard' procedure for cholecystectomy. However, this procedure can be dangerous in cases of unclear anatomy at the Callot's triangle. A significant proportion of patients with unclear anatomy are still converted to 'open' to complete the procedure. The other option is subtotal cholecystectomy rather than open conversion. Our purpose was to study the safety of laparoscopic subtotal cholecystectomy in cases where the clear identification of the anatomical land marks in Callot's triangle is difficult. Materials and methods Patients who underwent laparoscopic subtotal cholecystectomy between January 2011 and December 2011 were evaluated prospectively. These patients underwent subtotal cholecystectomy without isolation of the duct or artery, as this was judged to be hazardous, and the Hartmann pouch was transacted, stones were evacuated and the gall bladder remnant was closed by endoscopic sutures and a subhepatic drain left in situ. Results Laparoscopic subtotal cholecystectomy was performed in 30 elective procedures among 30 patients, male patients 18 (60%) and female patients 12 (40%). Their mean age was 52.6 years ± 12.65 SD. The mean operative time was 92 min ± 20 SD, and the mean hospital stay was 72.43 h ± 22 SD. We encountered one conversion into open and two patients who developed intra-abdominal collection. No mortalities were recorded. Conclusion Subtotal cholecystectomy is a safe procedure in cases where there is no clear identification of the structures in Callot's triangle. However, it is not a substitute for conversion into open, if deemed required.

Rare presentation of postcholecystectomy syndrome: Magnetic resonance cholangiopancreatography findings of remnant gallbladder

Kolesistektomi sonrasi ameliyat nedeni olan klinik semptomlarin devam etmesi post-kolesistektomi sendromu olarak tanimlanir. Safra yollarina ait ve safra yollari disi nedenlere bagli gelisebilmektedir. Sik nedenleri arasinda biliyer darliklar, unutulan/tekrarlayan biliyer tas, Oddi sfinkteri diskinezisi ya da darligi bulunmaktadir. Yetersiz kolesistektomi sonrasi remnant safra kesesi ve remnant kese icerisinde tas varligi postkolesistektomi sendromunun nadir etyolojileri arasinda yer almaktadir. Biz bu calismada iki olguda, manyetik rezonans koledokopankreotografi (MRKP) ile post-kolesistektomi sendromunun nadir bir nedeni olan remnant safra kesesi bulgularini ortaya koymayi amacladik.

Post-cholecystectomy Syndrome Due To Stump-Stones: A Possibility

Recurrence of biliary symptoms following cholecystectomy either laparotomic or laparoscopic, is quite common. Causes are either biliary or extra-biliary. Symptoms of biliary origin chiefly depends on residual stones, biliary stricture, rarely depends on stones in cystic duct or gallbladder remnant. Diagnosis of stump-stones is difficult, mainly arising from USG, MRCP,CT-scan, ERCP. Completion cholecystectomy can be done by laparotomy or laparoscopically. We report two cases of stump-stones discovered after 10 years &amp; 5 years following lap chole and minilap cholecystectomy respectively, who were diagnosed by USG, CT-scan and managed by open completion cholecystectomy. Stump-stones can be a possibility of post cholecystectomy syndrome even after 10 years and surgeons should be aware of it.&#x0D; JCMCTA 2014 ; 25 (2) : 49-53