Clinical analysis of residual gallbladder:a comparison of three operative techniques of cholecystectomy / 解放军医学杂志

ABSTRACT

Objective To observe the incidence of residual gallbladder in patients undergone cholecystectomy through laparotomy (OC),mini-incision laparotomy cholecystectomy (MC) or laparoscopic cholecystectomy (LC),and to explore the causes,diagnosis,prevention and treatment of residual gallbladder.Methods The clinical data of 241 patients undergone laparotomy cholecystectomy (OC group),231 patients undergone mini-incision laparotomy cholecystectomy (MC group) and 290 patients undergone laparoscopic cholecystectomy (LC group) were retrospectively analyzed,and the incidence of residual gallbladder was compared among the three groups.Results Residual gallbladder was found in 32 patients after the surgical procedures,with 4 in OC group (1.7%),13 in MC group (5.6%) and 15 in LC group (5.2%),respectively.Statistical analysis showed that the incidence of residual gallbladder was lower in OC group than in MC and LC group (P0.05).Multivariate analysis showed that severity of inflammation before the operation,operative methods and operator's experience were correlated with the incidence of residual gallbladder.All the 32 cases were diagnosed by ultrasonography,computed tomography (CT),magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP).24 patients were cured with surgical procedure,and the symptoms disappeared during a follow-up period of 6 months to 9 years;other 8 cases were treated with conservative management and the results were unsatisfactory.The pathological examination showed no tumor or malignant change in the excised specimen.Conclusions Residual gallbladder is not a negligible complication of cholecystectomy.Effective control of inflammation of the gallbladder,selection of a proper time and procedure of operation,and the operation done by an experienced surgeon can reduce the incidence of residual gallbladder,and reoperation is the effective treatment for it.