Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting

Abstract

Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach.

Development of acute cholecystitis following laparoscopic partial cholecystectomy

“…However, there is a high possibility that the operation will need to be changed to open surgery because of potential adhesions (9). In the case presented here, there was a very low possibility of a laparoscopic operation because of adhesions and the location of the abscess.…”

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

“…Only then did policy makers become keen on implementing the service. The lobby team also supported their plan by accruing regional data to demonstrate the benefits of laparoscopy in Caribbean nations 2,16,17,19–24

We suggest that an audit of existing practice is indispensable as a part of the feasibility study.

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“…We believe this was due to the educational focus, with the UWI staff proctoring postgraduate residents and attending grade surgeons who were not exposed to laparoscopic practice. It has already been noted that most Caribbean surgeons have adapted their techniques to suit their practice environment 19–24. Therefore, this type of cross-fertilization from practicing Caribbean surgeons sharing these experiences and technical modifications is critical to develop sustainable laparoscopic practice.…”

Advancement of laparoscopic surgery in Guyana: a working model for developing countries

“…The GHPC administration was receptive, especially since the benefits of laparoscopy were well documented in neighboring Caribbean territories 8–14. The lobby group asked the GHPC to demonstrate their commitment by hosting the laparoscopic workshop in Guyana.…”

“…They also recognized that surgeons in the Caribbean had become innovative in order to reduce the number of consumables required for laparoscopic operations 8–14. This included the use of reusable trocars/instruments,8–11 use of laparoscopic suturing13 instead of staples or clips, and modification of surgical techniques to suit low-resource settings 11–13. Therefore, a deliberate attempt was made to invite Caribbean surgeons as proctors for laparoscopy in Guyana.…”