Laparoscopic Completion Cholecystectomy: An Audit from the Americas Hepato-Pancreato-Biliary Association (AHPBA) Caribbean Chapter

Abstract

Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean. Methods We carried out an audit of the databases from all hepatobiliary surgeons in the Anglophone Caribbean. We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018. Retrospective chart review was performed to extract the following data: patient demographics, diagnoses, presenting complaints, operative details, morbidity, mortality, and clinical outcomes. Descriptive statistics were generated using Statistical Packaging for Social Sciences (SPSS), version 12.0 (SPSS Inc., Chicago IL) Results There were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant. There were 10 women and two men at a mean age of 47.4 years (range 32-60; standard deviation (SD) +/-7.81; median 48; mode 52) and a mean body mass index (BMI) of 30.8 Kg/M 2 (SD +/-3.81; range 26-38; median 29.5). The mean interval between the index operation and the completion operation was 14.8 months (SD +/-12.3; range 1-48; median 13; mode 18). Five (42%) patients had their original cholecystectomy using the open approach. Five (42%) index operations were done on an emergent basis and the gallbladder remnant was deliberately left behind in three (25%) index operations. The completion cholecystectomies were all completed laparoscopically in 130.5 minutes (SD +/-30.5; range 90-180, median 125; mode 125) without any conversions or mortality. There were two minor bile leaks that resolved without intervention through an indwelling drain. Discussion Completions cholecystectomy can be completed via the laparoscopic approach with good outcomes and acceptable morbidity and mortality rates. The patients derive the same advantages as elective cholecystectomies. Therefore, the laparoscopic approach, when performed by hepatobiliary surgeons with advanced laparoscopic expertise in specialized centers, should be the new standard of care.

Robot-Assisted Common Bile Duct Exploration in Trinidad & Tobago

“…We also agree with other authors that it is important for the surgeon who wishes to undertake laparoscopic CBD exploration to have a working knowledge of biliary anatomy and variations [10,15], the ability to properly interpret intra-operative cholangiograms [16][17], an armamentarium of different approaches to duct exploration, stone extraction and closure [10,18,19], and the ability to suture laparoscopically [18,19].…”

Indications and Outcomes of Completion Cholecystectomy: A 5-year Experience From a Rural Tertiary Center

“…Our CC rate falls within the reported range in the literature which has been shown to be between 1.8% and 8.8% for CC following STC. 6,8 Our findings identified that all CC had a residual gallbladder remnant of at least 2.5 cm, which is longer that what is recommended gallbladder infundibular remnant size after STC (usually <1 cm). 15,20 This emphasizes the importance of performing STC to described standards of removing the entire anterior-lateral walls of the gallbladder down to within 1 cm of the cystic orifice.…”

“…Our CC rate falls within the reported range in the literature which has been shown to be between 1.8% and 8.8% for CC following STC. 6,8…”

Robotic‐assisted completion cholecystectomy: A safe and effective approach to a challenging surgical scenario – A single center retrospective cohort study

“…report a 0% conversion rate. However, one study included previous tube cholecystostomy in completion cholecystectomy patients, and the majority of patients studied suffered from remnant cystic stump cholecystitis – not a gallbladder remnant 14,24 . All 26 patients in the current study were performed without a conversion and involved a gallbladder remnant.…”

“…In previously published laparoscopic completion cholecystectomy case series, conversion rates to open are reported as high as 40%. 14,15,20 14,24 All 26 patients in the current study were performed without a conversion and involved a gallbladder remnant. The ability to perform this procedure in minimally invasive fashion can be expected to confer the same advantages of the minimally invasive approach to cholecystectomy in comparison with an open approach (decreased morbidity, mortality and length of stay).…”