Endoscopic retrograde removal of gallbladder remnant calculus

Shelton, Joseph H.; Mallat, Damien

doi:10.1016/j.gie.2006.01.042

Cited by 9 publications

(8 citation statements)

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“…Hence, they advised the routine use of intraoperative cholangiography to reduce the incidence of postcholecystectomy syndrome. Other modalities of treatment are extracorporeal shockwave lithotripsy and endoscopic retrograde removal of gallbladder remnant stones . These modalities are useful when surgery is contraindicated .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic completion cholecystectomy: A retrospective study of 40 cases

Parmar

Khandelwal

Mathew

et al. 2012

Asian J Endoscop Surgery

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Section: Discussionmentioning

confidence: 99%

Laparoscopic completion cholecystectomy: A retrospective study of 40 cases

Parmar

Khandelwal

Mathew

et al. 2012

Asian J Endoscop Surgery

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“…The treatment of symptomatic RGB is completion cholecystectomy of the remnant gallbladder. Although there are a few case reports of management of RGB stones with ERCP/extracorporeal shockwave lithotripsy, 10 26 27 28 29 we believe that it does not treat the cause of the pathology, i.e., the RGB. The surgical removal of a RGB can be technically demanding since these patients usually have a history of difficult gallbladder pathology that is further compounded by adhesions due to the initial surgery.…”

Section: Discussionmentioning

confidence: 91%

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

Singh

Kapoor

Singh

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsA 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.MethodsThis study involved a retrospective analysis of patients managed for symptomatic RGB from January 2000 to December 2015.ResultsA 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.ConclusionsPost-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.

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“…17,18 Other modalities like ERCP with basket, laser/electrohydraulic or mechanical lithotripter over a guide wire, cholangioscopy, ESWL with or without endoscopic removal of fragmented stones, and transcutaneous Fogarty balloon catheter deployment have been successfully tried in an attempt to remove stones in these remnants as an alternative to surgery. [19][20][21][22] These procedures are particularly helpful when the patient is unfit for surgery, provided the expertise is available. Traditionally, the open technique was considered as the procedure of choice for tackling these cystic duct remnant stones.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

Palanivelu

Rangarajan

Jategaonkar

et al. 2009

annals

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INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from 'post-cholecystectomy syndrome'. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6-10.7 months). The mean operating time was 103.5 min (range, 75-132 min). Duration of hospital stay was 4-12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy -13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. 'T'-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.

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Endoscopic retrograde removal of gallbladder remnant calculus

Cited by 9 publications

References 0 publications

Laparoscopic completion cholecystectomy: A retrospective study of 40 cases

Laparoscopic completion cholecystectomy: A retrospective study of 40 cases

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

Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

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