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The Indian Journal of Surgery logoLink to The Indian Journal of Surgery
. 2010 Aug 26;72(3):220–225. doi: 10.1007/s12262-010-0058-8

Residual gallstone disease — Laparoscopic management

Pradeep Chowbey 1,✉, Vandana Soni 1, Anil Sharma 1, Rajesh Khullar 1, Manish Baijal 1
PMCID: PMC3452661  PMID: 23133251

Abstract

Background

A few patients who continue to suffer antecedent symptoms following laparoscopic cholecystectomy (LC) may harbor residual gallstones. The incidence of residual gallstones following cholecystectomy is <2.5%. Many of these patients require a completion cholecystectomy to ameliorate their symptoms.

Materials and methods

We reviewed our experience of laparoscopic re-intervention for residual gallstones over a period of 10 years from January 1998 to December 2007. Twenty six patients underwent Laparoscopic completion cholecystectomy (LCC) for residual gallstone disease. Twelve patients had a previous LC (2 patients — subtotal cholecystectomy) and 9 patients had a previous open cholecystectomy (7 patients — subtotal cholecystectomy). Five patients had previously undergone a cholecystostomy. Diagnostic investigations included abdominal ultrasound, endoscopic ultrasound (EUS), magnetic resonance cholangio-pancreatography (MRCP) and endoscopic retrograde cholangio-pancreatography (ERCP).

Results

Findings included a remnant gallbladder in 3 patients, long cystic duct stump with impacted stone in 18 patients and a contracted gallbladder in 5 patients. All procedures were successfully completed laparoscopically. The mean operative time was 62 minutes and mean blood loss 50cc. Ten patient required abdominal drains postoperatively. Two patients had bilious drainage lasting 9 days and 11 days respectively. One patient died a week following surgery of acute myocardial infarction. Another patient died 6 months later of unrelated causes. The remaining patients have remained symptom free at a mean follow up of 3.2 years (range 7 months to 9 years).

Conclusion

The possibility of residual gallstones increases with subtotal cholecystectomy and inadequate dissection of the Calot’s triangle in the presence of acute inflammation. Laparoscopic re-intervention for treating residual gallstone disease is feasible and can be safely performed in centers of expertise.

Keywords: Residual gallstones, Completion cholecystectomy, Remnant gallbladder

Full Text

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