Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience

Abstract

Objective

Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease. Despite its success, approximately 10% of patients may experience persistent biliary symptoms, leading to the post-cholecystectomy syndrome. A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome. The objective of this study was to shed light on the clinical manifestations, evaluation, therapeutic strategies, and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.

Methods

This was a retrospective study, conducted over a five-year period (January 2017 to December 2022) at Apollo Hospitals in South India. All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included. The following data were collected: patient demographics, symptoms, preoperative investigations, intraoperative details and post operative outcomes.

Results

In total, 36 patients were included and analysed. The majority of patients were male (25, 69.4%), with a mean age of 50.7 ± 12.1 years. The most common presentation was pain in the upper abdomen or right upper quadrant region (24, 66.7%). The laparoscopic approach was attempted in all patients, with a success rate of 94.4%. Two patients required conversion to open surgery. Cholecystoenteric fistula to the colon was observed in one patient. Choledocholithiasis was observed in 7 patients (19.4%), and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.

Conclusion

Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection. Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy, a complex procedure associated with certain risks. This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.