Resection of the remnant gallbladder after subtotal cholecystectomy: An institutional experience.

Abstract

Background: Laparoscopic subtotal cholecystectomy is an acceptable method of preventing bile duct injuries in "difficult" gallbladders. However, it is associated with postoperative bile leaks and retained gallstones that may necessitate resection of the gallbladder remnant. This study evaluates the outcomes of patients who underwent completion cholecystectomy for ongoing symptoms or complication after subtotal cholecystectomy.

Methods: We performed a retrospective review of adults who underwent laparoscopic completion cholecystectomy after previous subtotal cholecystectomy at a single institution from 2009 to 2023. Indications for reoperation were collected and intraoperative findings, operative outcomes, and rates of postoperative morbidity were evaluated.

Results: Over 14 years, 46 patients underwent completion cholecystectomy, with 40 (80%) in the last 5 years. Remnant cholecystitis was the most common reason for reoperation in 37 patients (80.4%). Choledocholithiasis was seen in 4 cases (8.7%). Bile leak, gallstone pancreatitis, and abdominal abscess were observed in 8 (17.4%), 4 (8.7%), and 5 (10.8%) patients, respectively. Four patients (8.7%) had intestinal fistulas intraoperatively. Laparoscopic completion cholecystectomy was attempted in all, with 2 (4.4%) converted to open laparotomy. The median operative time was 111 minutes (interquartile range, 83-140 minutes), and the median hospital stay was 1 day (interquartile range, 0-2 days). Minor complications occurred in 5 patients (10.9%), which were managed conservatively. Four patients had major complications requiring endoscopic retrograde cholangiopancreatography or percutaneous intervention. There were no bile duct injuries or reoperations, and 44 (95.6%) patients had complete symptom resolution at follow-up.

Conclusion: Laparoscopic completion cholecystectomy is feasible and safe but technically challenging. With the increased use of subtotal cholecystectomy, patients presenting with persistent postoperative pain require timely work-up and management of their symptoms.