Detection of the communicating accessory bile duct in laparoscopic resection of residual gallbladder by the combination of the indocyanine green fluorescence cholangiography and the intraoperative cholangiography: A case report.

BACKGROUND: The partial cholecystectomy may be performed while in complicated laparoscopic cholecystectomy (LC). Biliary anomalies especially the accessory bile duct are established high risk of bile duct injury (BDI) in LC. Laparoscopic resection of residual gallbladder is a challenging procedure and extremely vulnerable to BDI. We report the execution of a laparoscopic resection of residual gallbladder with a communicating accessory bile duct using indocyanine green (ICG) fluorescence cholangiography and the intraoperative cholangiography (IOC). A case that has not been reported previously. PRESENTATION OF CASE: A 29-year-old female with history of laparoscopic partial cholecystectomy was admitted in our hospital. Magnetic resonance cholangiopancreatography (MRCP) revealed the residual gallbladder with an accessory bile duct. Considering the complexity of this patient, we performed a laparoscopic surgery using ICG fluorescence cholangiography. ICG was injected intravenously 1 h before the surgery, the residual gallbladder and the extrahepatic biliary structures including the accessory bile duct were imaged in green in fluorescence imaging that could be recognized clearly. IOC revealed that residual gallbladder communicated with intrahepatic bile duct through the accessory bile duct and drained into the common bile duct (CBD). The entire procedure was performed smoothly and successfully without bile duct injuries. DISCUSSION: Laparoscopic resection of residual gallbladder is a challenging procedure. Fluorescence cholangiography using ICG is regarded as a novel technique that could provide a real-time imaging intraoperative, which allowed to recognize and identify the residual gallbladder and the extrahepatic bile duct. IOC is also important in identifying a communicating accessory bile duct. Under the guidance of them, we completed this laparoscopic surgery. CONCLUSIONS: The combination of fluorescence cholangiography using ICG and IOC have profound significance in complicated LC.

The second 'gallbladder operation'.

Background: Subtotal cholecystectomy has been reported in 8% and 3.3% of patients undergoing open and laparoscopic cholecystectomy, respectively. According to a recent nationwide survey, the utilisation of subtotal cholecystectomy in the treatment of acute cholecystitis is on the rise. In 1.8% of subtotal cholecystectomies, a reoperation is required. Reoperations for residual gallbladder (GB), gallstones, and related complications accounted for half of the reoperations described in the literature after subtotal cholecystectomy. The purpose of this study was to evaluate the clinical profile, risk of complications, and feasibility of laparoscopic approaches and surgical procedures in patients with recurrent symptoms from a residual GB that necessitated a completion cholecystectomy. Methods: Patients who underwent surgery for residual GB with stones and/or complications between January 2007 and January 2020 were included in the study group. A prospectively maintained database was used to review patient information retrospectively. The demographic profile, operation details of the index surgery, current presentation, investigations performed, surgery details, morbidity and mortality were all included in the clinical information. Results: There were 13 patients who underwent completion cholecystectomy. The median age was 55 years (22-63 years). Prior operative notes mentioned subtotal cholecystectomy in only seven patients. The average time between the index surgery and the onset of symptoms was 30 months (2-175 months). A final diagnosis of residual GB with or without calculi was made by ultrasound (USG) in 11 patients and by magnetic resonance cholangiopancreatography (MRCP) in two others. Choledocholithiasis (n = 4, 30.7%), acute cholecystitis (n = 2, one with empyema and GB perforation) and Mirizzi syndrome (n = 1) were seen as complications of residual gallstones in seven patients. All 13 patients underwent successful laparoscopic procedures. A fifth port was used in all. A critical view of safety was achieved in 12 patients. Two patients required laparoscopic common bile duct (CBD) exploration for CBD stones. Intraoperative cholangiograms were done in eight patients (61.5%). There were no conversions, injuries to the bile duct or deaths. Morbidity was seen in one. The patient required therapeutic endoscopic retrograde cholangiography for cholangitis and CBD clearance on the fifth post-operative day. The median hospital stay was 4 days (3-7 days). At a median follow-up of 99 months, symptom resolution was seen in all 13 patients. Conclusion: Gallstones in the residual GB are associated with more complications than conventional gallstones. The diagnosis requires a high level of suspicion. MRCP is more accurate in establishing the diagnosis and identifying the associated complications, even if the diagnosis is made on USG in most patients. A pre-operative roadmap is provided by the MRCP. For patients with residual GB, laparoscopic completion cholecystectomy is a feasible and safe option.

The complications of subtotal cholecystectomy: A case report.

INTRODUCTION: Although the symptoms attributed to gall stones resolve in most patients after cholecystectomy, some may have symptoms that persist or recur. It is known as the post-cholecystectomy syndrome (PCS). The aim of this case was to describe the diagnostic difficulties encountered and to discuss the main etiologies of this entity. CASE REPORT: A 54-year-old man presented for a recurrent right upper quadrant pain despite laparoscopic cholecystectomy five years ago. Imaging showed cystic lesion at the gallbladder fossa with gallstones. We decided to reoperate the patient by laparoscopic approach. It turned to be a residual gallbladder with stones inside. It was confirmed by histopathology. He was asymptomatic after a follow-up of 2 years. DISCUSSION: The PCS should not be trivialized. Most of the causes are allocated to extra biliary etiologies. They must be ruled out first as most of them can be controlled with medication. There are etiologies for which re-operation can be necessary. CONCLUSION: The indication of cholecystectomy must be taken wisely otherwise surgery will not solve the problem. Even though patient may complain of persistence or recurrence of the pain. In this case, it can be a real challenge for both diagnosis and treatment.

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

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.

Diagnosis and surgical therapy for residual gallbladder in 52 cases / 中华普通外科杂志

Objective To evaluate the diagnosis and treatment of residual gallbladder.Methods The diagnosis of residual gallbladder depends on a history of previous cholecystectomy and postoperative existent symptoms suggesting cholecystitis.In this series the diagnosis was finally established by ultrasonography and laparotomy in 52 cases.Results Ten cases received laparoscopic residual cholecystectomy,32 cases underwent residual cholecystectomy,7 cases did residual cholecystectomy plus common bile duct exploration,1 case was treated with residual cholecystectomy,common bile duct exploration and left lateral lobe hepatectomy,1 case with residual cholecystectomy,common bile duct exploration,cholangioenterostomy,1 case by radical resection of residual gallbladder cancer.Conclusions Residual gallbladder is a secondary disease,diagnosis is not difficult,surgery has certain difficulty,the application of intraoperative ultrasound and choledochoscope has great value.

Clinical analysis of residual gallbladder disease after laparoscopic cholecystectomy / 局解手术学杂志

Objective To analyze the causes of residual gallbladder disease after claparoscopic cholecystectomy. Methods From Feb-ruary 2006 to February 2013, there were 30 patients with residual gallbladder disease after laparoscopic cholecystectomy, and they were given second surgery in our hospital. Results The residual gallbladder lesions were successfully removed. Symtoms before operation were relieved or disappear. The average duration of hospital stays was 8. 2 d. The difference between before and after surgery was statistically significant(P<0. 05). There were 2 cases of delayed wound healing, and the others were of good curative effect. And blood test indicators of all the pa-tients recovered to normal when they leave hospital. Conclusion The surgery was carried out strictly accordding to the relevant procedure to prevent the occurrence of residual cystic lesions. If the patients were found to have obvious symptoms of residual gallbladder disease,they should be early diagnosed and recieved second surgery as soon as possible so as to cure disease and improve quality of life after surgery.

The diagnostic value of ultrasound for the residual gallbladder / 中国基层医药

Objective To explore the diagnostic value of ultrasonography for the residual gallbladder after cholecystectomy.Methods Application of the ultrasound diagnostic apparatus in cholecystectomy patients was to be screened to find the residual gallbladder.Results Ultrasound resuts showed 18 cases of residual gallbladder,which combined stones in 12 cases(66.7％ ),polyps in 1 case(5.6％ ) ;Atrophic cholecystitis,acute cholecystitis,postoperative residual gallbladder probability were high,accounting for 83.0％.Conclusion Ultrasound for the preoperative prevention and postoperative diagnosis of the residual gallbladder has better value,and the cholecystectomy patients should be routinely review the ultrasound.

Litíase sintomática em vesícula biliar residual / Symptomatic lithiasis in residual gallbladder

Sintomas pós-colecistectomia muitas vezes tem causas extra-biliares. As causas biliares mais comuns são presença de cálculos ou cirurgia incompleta. O uso da colangiorressonância magnética pode evitar complicações intraoperatórias decorrentes anatomia biliar pouco usual facilitando o acesso cirúrgico. No presente trabalho é relatado caso de paciente com litíase sintomática em vesícula residual.

Most post cholecystectomy symptoms have extrabiliary causes. The most common biliary causes are calculi and incomplete surgery. The use of magnetic resonance cholangiography (MRC) seems to avoid intraoperative complications due to a possible unusual biliary anatomy and to facilitate surgical access. Here in is reported a case of patient with symptomatic lithiasis in residual gallbladder.

Analysis of residual gallbladder stones and acute pancreatitis with 8 cases / 国际外科学杂志

Objective To study the residual gallbladder stones and the relationship between the onset of acute pancreatitis and its surgical treatment.Methods Retrospective analysis was made in 13 patients with residual gallbladder admitted tO the hospital from June 1998 to December 2007,of which 8 cases of residual gallbladder stones and acute pancreatitis were invostigated.Thirteen cases of patients had underovent cholecystectomy 2 to 9 years before,the first symptoms occurred before 1 month to 8 years.Other remnants of the gallbladder were diagnosed by B-ultrasound and CT,magnetic resonance cholangiopancreatography (MRCP).Results Two cases were confirmedas pigment stones;6 cases as cholesterol stones(size0.2 cm ～0.5 cm,an average of 3.2 cm);1 cases as anonlalous pancre-aticobiliary junction(anomalous pancreaticobiliary ductal union,APBDU);5 cases as anomal;8 cases(61.5%)as episode of acute pancreatitis.Au patients underwent resection of residual gallbladder,with line choledochal cyst excision and biliary-enteric Roux-en-Y internal drainage in 1 case.choledocholithotomy T-tube drainage in 3 cases.Postoperative follow-up of residual gallstone was done in 8 cases,no pancreatitis attack in 6 cases,pancreatitis attack in 2 cases.Significant difference was found in onset of acute pancreatitis (P=0.019,P<0.05).Five patients without stones in patients with postoperative all none pancreatitis attack.Conclusion Patients with residual gallbladder stones are prone to acute pancreatitis,and cholecystectomy for patients with residual treatment Can reduce the pancreatitis attack.

Treatment and prevention of residual gallbladder: a report of 56 cases / 中华肝胆外科杂志

Objective To explore methods for the treatment and prevention of residual gallbladder.Methods Clinical data of 56 patients with residual gallbladder were retrospectively analyzed.Results All 56 cases were diagnosed through clinical imaging examination and cured by selective operation of residual gallbladder resection.Conclusion The residual gallbladder can be diagnosed by repeated biliary symptoms in patients with a history of cholecystectomy and imaging examination.Residual gallbladder resection is an effective therapy for the treatment of residual gallbladder.

Vesícula residual / Residual gallbladder

Our objective is to report three patients with recurrent severe upper abdominal pain secondary to residual gallbladder. All patients had been subjected to cholecystectomy from 1 to 20 years before. The diagnosis was established after several episodes of severe upper abdominal pain by imaging exams: ultrasonography, tomography, or endoscopic retrograde cholangiography. Removal of the residual gallbladder led to complete resolution of symptoms. Partial removal of the gallbladder is a very rare cause of postcholecystectomy symptoms.