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Residual gallstone disease - Laparoscopic management.
Pradeep Chowbey1, Vandana Soni, Anil Sharma
1Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India.
The Indian Journal of Surgery
|November 8, 2012
Summary
Residual gallstones after gallbladder removal can cause symptoms. Laparoscopic completion cholecystectomy is a safe and effective treatment for these residual gallstones, leading to symptom relief.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biliary Tract Surgery
Background:
- Residual gallstones can cause persistent symptoms after laparoscopic cholecystectomy (LC).
- The incidence of residual gallstones post-cholecystectomy is less than 2.5%.
- Completion cholecystectomy is often required to manage these symptoms.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic re-intervention for residual gallstones.
- To analyze the causes and management strategies for residual gallstone disease.
Main Methods:
- A 10-year review of 26 patients undergoing laparoscopic completion cholecystectomy (LCC) for residual gallstones.
- Inclusion of patients with prior LC, open cholecystectomy, or cholecystostomy.
- Diagnostic tools included ultrasound, EUS, MRCP, and ERCP.
Main Results:
- Common findings included impacted stones in the cystic duct stump (18 patients) and remnant gallbladders.
- All LCC procedures were successful with a mean operative time of 62 minutes and minimal blood loss.
- Most patients remained symptom-free at a mean follow-up of 3.2 years.
Conclusions:
- Subtotal cholecystectomy and inadequate Calot's triangle dissection increase the risk of residual gallstones.
- Laparoscopic re-intervention for residual gallstones is a safe and effective procedure in experienced centers.