Management of residual gall bladder : A 15-year experience from a north Indian tertiary care centre :A 15-year experience from a north Indian tertiary care centre

Ashish Singh; Abhimanyu Kapoor; Rajneesh Kumar Singh; Anand Prakash; Anu Behari; Ashok Kumar; Vinay Kumar Kapoor; Rajan Saxena

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저자정보: Ashish Singh (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Abhimanyu Kapoor (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Rajneesh Kumar Singh (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Anand Prakash (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Anu Behari (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Ashok Kumar (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Vinay Kumar Kapoor (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Rajan Saxena (Sanjay Gandhi Post Graduate Institute of Medical Sciences)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제22권 제1호

발행연도: 2018.2

수록면: 36 - 41 (6page)

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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.

#Subtotal cholecystectomy #Residual gallbladder #Completion cholecystectomy #Laparoscopic cholecystectomy #Open cholecystectomy

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