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KMID : 1143920190230040353
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Annals of Hepato-Biliary-Pancreatic Surgery
2019 Volume.23 No. 4 p.353 ~ p.358
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Residual gall bladder: An emerging disease after safe cholecystectomy
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Gupta Vikas
Sharma Anil Kumar
Kumar Pradeep
Gupta Mantavya
Gulati Ajay
Sinha Saroj Kant
Kochhar Rakesh
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Abstract
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Backgrounds/Aims: Residual gallbladder mucosa left after subtotal/partial cholecystectomy is prone to develop recurrent lithiasis and become symptomatic, which mandates surgical removal.
Methods: we retrospectively evaluated the patients with residual gallbladder referred to us from January 2011 to December 2017. Based on MRCP we classified calot’s anatomy to ? type I where cystic duct was seen and type II where sessile GB stump was seen.
Results: 21 patients with median age 38 years and M:F::1:9.5, had undergone cholecystectomy (3 months-20 years) prior, presented with recurrent biliary pain. 3 had jaundice (CBD stone, Mirizzi and biliary stricture), 1 had pancreatitis and one had malignancy of the GB. Imaging revealed type I anatomy in 14 (67%) and type II in 7 (33%). All underwent completion cholecystectomy ? open in 18 and laparoscopic in 3 (one converted to open). Additional procedure was required in 5 patients ? CBD exploration in 2 (10%) and one each Hepatico-jejunostomy, extended cholecystectomy and splenectomy. Median hospital stay was 1 day. There was no mortality and 10% morbidity. One patient with malignancy died at 2 years, two died of unrelated cause, one developed incisional hernia and the remaining were well at a median follow up of 29 months.
Conclusions: Residual GB lithiasis should be suspected if there are recurrent symptoms after cholecystectomy. MRCP based proposed classification can guide the management strategy. Completion cholecystectomy is curative.
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KEYWORD
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Gall bladder, Cholecystectomy, Residual, Cystic duct, Remnant, Recurrent
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