|
KMID : 1143920180220010036
|
|
Annals of Hepato-Biliary-Pancreatic Surgery
2018 Volume.22 No. 1 p.36 ~ p.41
|
|
|
Management of residual gall bladder: A 15-year experience from a north Indian tertiary care centre
|
|
Singh Ashish
Kapoor Abhimanyu
Singh Rajneesh Kumar
Prakash Anand
Behari Anu
Kumar Ashok
Kapoor Vinay Kumar
Saxena Rajan
|
|
|
Abstract
|
|
|
Backgrounds/Aims: A residual gallbladder (RGB) following a partial/subtotal cholecystectomy may cause symptoms that require its removal. We present our large study regarding the problem of a RGB over a 15 year period.
Methods: This study involved a retrospective analysis of patients managed for symptomatic RGB from January 2000 to December 2015.
Results: A RGB was observed in 93 patients, who had a median age of 45 (25-70) years, and were comprised of 69 (74.2%) females. The most common presentation was recurrence pain (n=64, 68.8%). Associated choledocholithiasis was present in 23 patients (24.7%). An ultrasonography (USG) failed to diagnose RGB calculi in 10 (11%) patients; whereas, magnetic resonance cholangio-pancreatography (MRCP) accurately diagnosed RGB calculi in all the cases except for 2 (4%) and, additionally, detected common bile duct (CBD) stones in 12 patients. Completion cholecystectomy was performed in all patients (open 45 [48.4%]; laparoscopic 48 [51.6%] and 19 [20.4%] patients required a conversion to open). The RGB pathology included stones in 90 (96.8%), Mirizzi’s syndrome in 10 (10.8%) and an internal fistula in 9 (9.7%) patients. Additional procedures included CBD exploration (n=6); Choledocho-duodenostomy (n=4) and Roux-en-Y hepatico-jejunostomy (n=3). The mortality and morbidity were nil and 11% (all wound infection), respectively. Two patients developed incisional hernia during follow up. The mean follow up duration was 23.1 months (3-108) in 65 patients and the outcome was excellent and good in 97% of the patients.
Conclusions: Post-cholecystectomy recurrent biliary colic should raise suspicion of RGB. MRCP is a useful investigation for the diagnosis and assessment of any associated problems and provides a roadmap for surgery. Laparoscopic completion cholecystectomy is feasible, but is technically difficult and has a high conversion rate.
|
|
|
KEYWORD
|
|
|
Subtotal cholecystectomy, Residual gallbladder, Completion cholecystectomy, Laparoscopic cholecystectomy, Open cholecystectomy
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
 
|