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Management of residual gall bladder: A 15-year experience from a north Indian tertiary care centre
Ann Hepatobiliary Pancreat Surg 2018 Feb;22(1):36-41
Published online February 28, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

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

Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
Received July 21, 2017; Revised August 15, 2017; Accepted August 31, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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. (Ann Hepatobiliary Pancreat Surg 2018;22:36-41)
Keywords : Subtotal cholecystectomy; Residual gallbladder; Completion cholecystectomy; Laparoscopic cholecystectomy; Open cholecystectomy


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