Kursat DİKMEN, Mustafa SARE, Hasan BOSTANCİ, Ahmet Çağrı BÜYÜKKASAP

Clinical characteristics and treatment approaches in patients with post-cholecystectomy syndrome due to remnant gallbladder

Aim: A remnant gallbladder is a rare problem encountered in the diagnosis and treatment of the post-cholecystectomy syndrome.This study aimed to evaluate the clinical features and treatment modalities of patients with a symptomatic remnant gallbladder aftercholecystectomy.Material and Methods: The data of 11 patients who were operated following the diagnosis of a remnant gallbladder between January2013 and January 2019 were evaluated retrospectively. Clinical characteristics, diagnosis and treatment management, laparoscopyto open conversion rate and hospital stay were evaluated.Results: The median age was 55.3 years (range, 36 to 77 years), and the male/female ratio was 1/10. Right upper quadrant pain andjaundice were the most common symptoms. The time interval between cholecystectomy and symptom recurrence was 46.8 (range,1 to 420) months. A remnant gallbladder was determined by ultrasonography in seven patients (63.6%) and by magnetic resonancecholangiopancreatography in 11 patients (100%). Preoperatively, ERCP was performed in six patients due to suspicion of stones inthe main bile duct, except for the remnant gallbladder. Complementary cholecystectomy was performed by laparoscopically in sevenpatients, and only four patients had a conversion to open surgery. The median duration of hospital stay was four days (range, 2 to9 days).Conclusion: The remnant gallbladder, which is the rare and a cause of the post-cholecystectomy syndrome, is a pathology thatshould be considered in patients with postoperative symptoms. Patients with a symptomatic remnant gallbladder should be treatedwith a multidisciplinary approach, including a careful choice of imaging modalities and surgical or endoscopic treatment methods.

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1. Isherwood J, Oakland K, Khanna A. A systematic review of the aetiology and management of post cholecystectomy syndrome. The Surgeon 2018;17:33-42.
2. Womack NA, Crider R. The persistence of symptoms following cholecystectomy. Ann Surg 1947;126:31-55.
3. Redwan AA. Multidisciplinary approaches for management of postcholecystectomy problems (surgery, endoscopy, and percutaneous approaches) Surg Laparosc Endosc Percutan Tech 2009;19:459-69.
4. Jaunoo SS, Mohandas S, Almaond LM. Post cholecystectomy syndrome (PCS). Int J Surg 2010;8:15-7.
5. Greenfield NP, Azziz AS, Jung AJ, et al. Imaging late complications of cholecystectomy. Clin Imaging 2012;36:763-7.
6. Terhaar OA, Abbas S, Thornton FJ, et al. Imaging patients with “post-cholecystectomy syndrome”: an algorithmic approach. Clin Radiol 2005;60:78-84.
7. Wani NA, Khan NA, Shah AI, et al. Post-cholecystectomy Mirizzi’s syndrome: magnetic resonance cholangiopancreatography demonstration. Saudi J Gastroenterol 2010;16:295-8.
8. Chowbey P, Sharma A, Goswami A, et al. Residual gallbladder stones after cholecystectomy: A literature review. J Minim Access Surg 2015;11:223-30.
9. Shirah BH, Shirah HA, Zafar SH, et al. Clinical patterns of postcholecystectomy syndrome. Ann Hepatobiliary Pancreat Surg 2018;22:52-7.
10. Sepe PS, Berzin TM, Sanaka S, et al. Single-operator cholangioscopy for the extraction of cystic duct stones. GIE 2012;25:206-10.
11. Palanivelu C, Rajan PS, Jani K, et al. Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants. J Am Coll Suery 2006;203:145-6.
12. Parmar AK, Khandelwal RG, Mathew MJ, et al. Laparoscopic completion cholecystectomy: a retrospective study of 40 cases. Asian J Endosc Surg 2013;6:96-9.
13. Gurel M, Sare M, Gurer S, et al. Laparoscopic removal of a gallbladder remnant. Surg Laprosc Endosc 1995;5:410-11.
14. Glenn F, McSherry CK. Secondary abdominal operations for symptoms following biliary tract surgery. Surg Gynecol Obstet 1965;121:979-88.
15. Rogy MA, Függer R, Herbst F, et al. Reoperation after cholecystectomy: the role of the cystic duct stump. HPB Suerg 1991;4:129-34.
16. Demettriades H, Pramateftakis MG, Kanellos I, et al. Retained gallbladder remnant after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2008;18:276-9.
17. Xing J, Rochester J, Reiter BP, et al. A phantom gallbladder on endoscopic retrograde cholangiopancreatography. WorldJ Gastroenterol 2007;13:6274-76.
18. Hellmig S, Katsoulis S, Fölsch U. Symptomatic cholecystolithiasis after laparoscopic cholecystectomy. Surg Endosc 2004;18:347.
19. Daly TD, Martin CJ, Cox MR. Residual gallbladder and cystic duct stones after laparoscopic cholecystectomy. ANZ J Surg 2002;72:375-77.
20. Ji W, Li LT, Li JS. Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis. Hepatobiliary Pancreat Dis Int 2006;5:584-9.
21. Philips JA, Lawes DA, Cook AJ, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc 2008;22:1697-700.
22. Michalowski K, Bornman PC, Krige JE, et al. Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 1998;85:904-6.
23. Sinha I, Smith ML, Safranek P, et al. Laparoscopic subtotal cholecystectomy without cystic duct ligation. Br J Surg 2008;95:534.
24. Horiuchi A, Watanabe Y, Doi T, et al. Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc 2008;22:2720-23.
25. Moody FG. Postcholecystectomy syndromes. Ann Surg 1987;19:205-20.
26. Kohga A, Suzuki K, Okumura T, et al. Calculus left in remnant gallbladder cause long-term complications in patients undergoing subtotal cholecystectomy. HPB (Oxford) 2019;21:508-14.
27. Lidsky ME, Speicher PJ, Ezekian B, et al. Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity. HPB 2017;19:547-56.
28. Beldi G, Glättli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 2003;17:1437-9.
29. Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy for “difficult gallbladders”: systematic review and meta-analysis. JAMA Surg 2015;150:159-68.
30. Kim JY, Kim KW, Ahn CS, et al. Spectrum of biliary and nonbiliary complications after laparoscopic cholecystectomy: Radiologic findings. AJR Am J Roentgenol 2008;191:783-89.
31. Somak Das S, Gopakumar C, Swain S, et al. Symptomatic cystic duct stump lithiasis 21years after cholecystectomy. Double Blind Peer Rev. Int Res J 2015;15:1-4.
32. Chowbey PK, Bandyopadhyay SK, Sharma A, et al. Laparoscopic reintervention for residual gallstone disease. Surg Laparosc Endosc Percutan Tech 2003;13:31-5.
33. Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: Experiences with 39 cases. World J Gastroenterol 2008;14:3081-84.