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Sabat N, Westcott A, Pretorius CF. A two-decade diagnostic dilemma of a post-cholecystectomy syndrome presenting with a remnant cystic stump stone causing Mirizzi syndrome. ANZ J Surg 2022; 92:3347-3349. [PMID: 35348262 DOI: 10.1111/ans.17652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Adrian Westcott
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Casper F Pretorius
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, James Cook University, Townsville, Queensland, Australia
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Ullah S, Yang BH, Liu D, Lu XY, Liu ZZ, Zhao LX, Zhang JY, Liu BR. Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study. World J Gastrointest Surg 2022; 14:470-481. [PMID: 35734621 PMCID: PMC9160690 DOI: 10.4240/wjgs.v14.i5.470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection. AIM To compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones. METHODS We adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs. RESULTS The technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in 17.4% (n = 15/86) of patients following LC (mainly women). CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
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Affiliation(s)
- Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bao-Hong Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Department of Oncology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xue-Yang Lu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Seleem WM, Hanafy AS, Abd-Elsalam S, Badawi R. Impact of laparoscopic cholecystectomy on the complexity of endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 2022; 34:142-145. [PMID: 33405419 DOI: 10.1097/meg.0000000000002017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES A scarce number of researches discussed the impact of cholecystectomies on the anatomy of common bile duct (CBD) and intern if this will affect the difficulty of endoscopic retrograde cholangiopancreatography (ERCP). The objective of present study was to assess the impact of complicated cholecystectomy on the complexity and safety of the ERCP procedure. STUDY DESIGN A total of 100 patients were enrolled after meeting the following inclusion criteria - study group (group A): 50 patients with previous history of complicated laparoscopic cholecystectomy and control group (group B): 50 patients with previous noncomplicated laparoscopic cholecystectomy. ERCP was performed and complexity was judged by a number of cannulation attempts, ERCP time, pancreatic cannulation and post-ERCP pancreatitis. RESULTS The study revealed prolonged ERCP procedure duration in noncomplicated cholecystectomy (24.2 ± 8.5 min) and it was significantly more prolonged in complicated cholecystectomy (39.6 ± 10.7 min; P = 0.03). The trials of cannulation attempts were significantly higher in the study group with complicated cholecystectomy (P = 0.009). Pancreatic duct cannulation was frequently higher in the complicated cholecystectomy group (P = 0.03). Difficult or failed stone extraction was significantly prevalent in the complicated cholecystectomy group and the occurrence of post-ERCP pancreatitis (PEP) was significantly higher than the control group. CONCLUSION ERCP after complicated laparoscopic cholecystectomy is more complex with increased duration liability of complications.
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Affiliation(s)
- Waseem M Seleem
- Internal Medicine Department, Hepatology and Endoscopy Division, Zagazig University
| | - Amr S Hanafy
- Internal Medicine Department, Hepatology and Endoscopy Division, Zagazig University
| | | | - Rehab Badawi
- Tropical Medicine Department Tanta University, Tanta, Egypt
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Laparoscopic Remnant Cholecystectomy With CBD Exploration: A Tertiary Center Experience. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:96-100. [PMID: 34570073 DOI: 10.1097/sle.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND After partial cholecystectomy, the remnant gallbladder can become symptomatic requiring surgical intervention. This study aims at assessing feasibility and safety of laparoscopic remnant cholecystectomy with common bile duct (CBD) exploration in patients having remnant gallbladder stones with choledocholithiasis. MATERIALS AND METHODS This retrospective observational study includes data obtained over a period of 10 years, from 2010 to 2020, in 2 tertiary care centers performing advanced laparoscopic surgery. Patients with remnant gallbladder stones with choledocholithiasis were include in this study. All of them underwent laparoscopic remnant cholecystectomy with CBD exploration. Demographic, perioperative and follow up data were collected and analyzed. RESULTS A total of 18 patients with a mean age of 47 years, male to female ratio of 1:3.5, with cholecystectomy done 10 months to 15 years back, were diagnosed with remnant gallbladder stones with choledocholithiasis during the period of 2010 to 2020. Five patients had undergone endoscopic retrograde cholangiopancreatography stenting of CBD 3 months to 2 years back. All of them underwent laparoscopic remnant cholecystectomy with CBD exploration. Trans cystic approach for CBD exploration was performed in 11 patients. In 7 patients, transductal CBD exploration was done, out of which, 1 patient needed T-tube placement. Median hospital stay was for 3 days. Morbidity rate was 5.56% at 30 days after operation. There was no recurrence of symptoms or mortality after a median follow up of 24 months (range: 5 to 60 mo). CONCLUSION Concurrent laparoscopic remnant cholecystectomy with CBD exploration is feasible, safe, and reproducible when performed in centers with experience in advanced laparoscopic surgery.
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Laparoscopic Completion Cholecystectomy for Residual Gallbladder and Cystic Duct Stump Stones: Our Experience and Review of Literature. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02559-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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SILODIA A, BAGHEL A, SAYTODE VP, DADORIYA AS, DWIVEDI G, SHARMA D, YADAV SK. An unexpected cause of acute pancreatitis: postcholecystectomy cystic duct stump stone. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yin Z, Zhu Y, Li Z, Jiang X, An W, Yin L, Yu L. Factors related to residual gallbladder calculi formation using computed tomography and magnetic resonance imaging combined with clinical data. J Int Med Res 2020; 48:300060520958968. [PMID: 32962472 PMCID: PMC7517991 DOI: 10.1177/0300060520958968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective We aimed to investigate risk factors related to remnant gallbladder (RGB) stones. Methods This retrospective study included 73 patients with RGB, in groups with and without RGB calculi. Univariate analyses were used to identify nine variables associated with RGB calculi: sex, age, body mass index (BMI), time to detection, surgical method, length of RGB, angle of RGB and common hepatic duct (CHD), choledocholithiasis, and remnant cholecystitis. Multivariate logistic regression was performed to assess independent predictors of RGB stones. A receiver operating characteristic (ROC) curve was used to estimate model accuracy and determine cut-off values of independent predictors. Results We enrolled 73 patients, 33 with and 40 without RGB stones. Univariate analyses showed that age, BMI, time to detection, length of RGB, angle of RGB and CHD were predictors for RGB calculi. Multivariate analyses indicated that time to detection, length of RGB, and angle of RGB and CHD were independent predictors for RGB calculi. The area under the ROC curve of the model was 0.940. Cut-off values of the three indicators were 1.5 years, 2.25 cm, and 22.5°, respectively. Conclusion Time to detection, length of RGB, and angle of RGB and CHD were independent predictors of RGB calculi.
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Affiliation(s)
- Zudong Yin
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanyan Zhu
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhangzhu Li
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiangsen Jiang
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei An
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Yin
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Yu
- Department of Radiology, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Ng C, Ejimakor M, Goldson TM, Forjuoh SN. The postcholecystectomy syndrome in morbid obesity. Proc (Bayl Univ Med Cent) 2020; 33:393-394. [DOI: 10.1080/08998280.2020.1757975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Cindy Ng
- Department of Family and Community Medicine, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Michelle Ejimakor
- Department of Family and Community Medicine, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Tove M. Goldson
- Department of Family and Community Medicine, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Samuel N. Forjuoh
- Department of Family and Community Medicine, Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine, Temple, Texas
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Yin Z, Cheng Y, Xiao Q, Xu G, Yang H, Zhou J, Fu Y, Chen J, Zhao L, Liang F. Acupuncture for the postcholecystectomy syndrome: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16769. [PMID: 31393398 PMCID: PMC6709185 DOI: 10.1097/md.0000000000016769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Postcholecystectomy syndrome (PCS) is a term used to describe the persistence of biliary colic or right upper quadrant abdominal pain with a variety of postoperative gastrointestinal symptoms. Acupuncture and related treatments have shown clinical effects for PCS in many studies. But the systematic reviews and meta-analyses for them are lacking. We aim to evaluate the efficacy and safety of acupuncture on the treatment of PCS. METHODS We will search 8 electronic databases, including the Web of Science, PubMed, Cochrane Library, Embase, and 4 Chinese databases (CBM, Wanfang, VIP, and CNKI databases), and additional sources (WHO ICTRP, ChiCTR, Clinical Trials, Grey Literature Database), for potentially eligible studies. Literature retrieval, screening, and data extraction will be conducted by 2 researchers independently. In case of disagreement, a 3rd party shall be consulted to assist judgment. We will use RevmanV.5.3 to perform a fixed effect meta-analysis on the data of clinical homogeneity studies, and evidence's level will be assessed through the method for GRADE. RESULTS This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in PCS. CONCLUSION The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control PCS. ETHICS AND DISSEMINATION Since this article does not involve patients' private data, no ethical approval is required. The agreement will be disseminated by peer-reviewed journals or conference reports. TRIAL REGISTRATION NUMBER PROSPERO CRD4201929287.
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Kar A, Gulati S, Mohammed S, Valappil MV, Sarala BB, Ghatak S, Bhattacharyya A. Surgical Management of Cystic Duct Stump Stone or Gall Bladder Remnant Stone. Indian J Surg 2018; 80:284-287. [PMID: 29973763 DOI: 10.1007/s12262-018-1724-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/15/2018] [Indexed: 01/10/2023] Open
Abstract
Retained calculi in the cystic duct or gall bladder remnant can present as a post-cholecystectomy problem. Increased suspicion is necessary to diagnose this condition in a symptomatic post-cholecystectomy patient. Ultrasonography usually detects this condition, but magnetic resonance cholangiopancreatography is the test of choice for diagnosis as well as for surgical planning. Laparoscopic re-excision of the stump in most cases is feasible and safe. It is increasingly becoming the treatment of choice.
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Affiliation(s)
- Abhimanyu Kar
- Department of Surgical Gastroenterology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Sumit Gulati
- Department of Surgical Gastroenterology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Sudheer Mohammed
- Department of Surgical Gastroenterology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Mithun Valiya Valappil
- Department of Surgical Gastroenterology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Bhaviya Bhargavan Sarala
- Department of General Surgery, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Supriyo Ghatak
- Department of Surgical Gastroenterology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
| | - Avik Bhattacharyya
- Department of Interventional Radiology, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700027 India
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Minimally Invasive Cholecystolithotomy to Treat Cholecystolithiasis in Children: A Single-center Experience With 23 Cases. Surg Laparosc Endosc Percutan Tech 2018; 27:e108-e110. [PMID: 28614174 DOI: 10.1097/sle.0000000000000429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Minimally invasive cholecystolithotomy is recently popularized treatment that may offer advantages over laparoscopic cholecystectomy, especially in China. However, there are few reports concerning the use of this technique in the pediatric population. This report describes our initial experience with minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy to treat cholecystolithiasis in children. MATERIALS AND METHODS A retrospective review of 23 pediatric patients with cholecystolithiasis who underwent minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy from January 2009 to December 2015 was performed. RESULTS The operations were successful in all 23 cases. None required conversion to conventional laparoscopic cholecystectomy. The average operative time was 68 minutes (range, 45 to 97 min). The average bleeding volume during surgery was 30 mL (range, 10 to 55 mL). The average length of hospital stay was 5.2 days (range, 3 to 7 d). There were no perioperative complications. All patients were followed for 9 to 12 months without any obvious gastrointestinal symptoms. None had a recurrence of stones in the gall bladder. CONCLUSIONS Minimally invasive cholecystolithotomy using laparoscopy combined with choledochoscopy is a safe and viable technique that may be used successfully in pediatric surgery.
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Singh A, Kapoor A, Singh RK, Prakash A, Behari A, Kumar A, Kapoor VK, Saxena R. Management of residual gall bladder: A 15-year experience from a north Indian tertiary care centre. Ann Hepatobiliary Pancreat Surg 2018. [PMID: 29536054 PMCID: PMC5845609 DOI: 10.14701/ahbps.2018.22.1.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Abhimanyu Kapoor
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Anand Prakash
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Vinay Kumar Kapoor
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Abstract
Backgrounds/Aims Postcholecystectomy syndrome represents a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. It is rare and under-reported in Saudi Arabia. It can be attributed to many complications such as bile duct injury, biliary leak, retained common bile duct stones, recurrent bile duct stones, and bile duct strictures. In this study, we aimed to analyze the causes and evaluate the approach to postcholecystectomy syndrome in our local Saudi Arabian community because of the vast number of cases encountered in our hospital for gallbladder clinical conditions and its related complications. Methods A prospective cohort database analysis of 272 patients who were diagnosed and treated for postcholecystectomy syndrome between January 2000 and December 2013 were reviewed. Results The incidence rate of postcholecystectomy syndrome was 19.8%. The male to female ratio was 1:1.45. The mean age was 37.41±7.12 years. The most common causes were as follows: No obvious cause in 50 (18.4%) patients, Helicobacter pylori infection in 43 (15.8%), pancreatitis in 42 (15.4%), peptic ulcer disease in 41 (15.1%), recurrent common bile duct (CBD) stone in 26 (9.6%), retained CBD stone in 22 (8.1%), bile leakage in 19 (7%), stenosis of the sphincter of Oddi in 12 (4.4%), cystic duct stump syndrome in 11 (4%), and CBD Stricture in 5 (1.8%). The mortality rate was 0%. Conclusions Any clinical presentation of postcholecystectomy should not be underestimated and be thoroughly investigated. Multidisciplinary collaboration is crucial for the best outcome and a safe approach for all the patients.
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Affiliation(s)
- Bader Hamza Shirah
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hamza Asaad Shirah
- Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia
| | - Syed Husham Zafar
- Department of Medicine, Al Ansar General Hospital, Medina, Saudi Arabia
| | - Khalid B Albeladi
- King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Zahedian A, Ahangar SK, Asghari Y. Post cholecystectomy syndrome need to redo laparoscopic completion surgery: A case report. Int J Surg Case Rep 2017; 42:145-147. [PMID: 29247966 PMCID: PMC5985252 DOI: 10.1016/j.ijscr.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cholecystectomy is the standard treatment for symptomatic gallbladder stone disease. However, symptoms such as abdominal pain and dyspepsia may persist even after surgery, if the gallbladder is incompletely removed known as postcholecystectomy syndrome. CASE PRESENTATION A 55-year-old man with a history of open cholecystectomy presented with a complaint of recurrent pain on his upper abdomen. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed a cystic structure in the gallbladder fossa, with a filling defect at the midpoint of the cystic duct, suggesting a retained stone in the cystic duct and residual gallbladder. Therefore, he underwent completion laparoscopic cholecystectomy. He had an uneventful postoperative period with relief of the recurrent pain. DISCUSSION Proper dissection and identification of the gallbladder and cystic duct junction is necessary for complete removal of the gallbladder and preventing postcholecystectomy syndrome. Patients with a retained stone in the residual gallbladder should undergo surgery, and the laparoscopic method can be performed by a surgeon with expertise in this revision surgery. CONCLUSION In post-cholecystectomy syndrome, symptomatic Patients with retained stone in partially removed gall bladder by open method needs laparoscopic cholecystectomy by an expert surgeon to relieve their symptoms.
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Affiliation(s)
- Ali Zahedian
- Clinical Research Development Center, Shahid Beheshti Hospital, Sargord Ghasemi Street, Shahid Keshvari Square, Babol, Mazandaran, Iran
| | - Sekineh Kamali Ahangar
- Clinical Research Development Center, Shahid Beheshti Hospital, Sargord Ghasemi Street, Shahid Keshvari Square, Babol, Mazandaran, Iran
| | - Yasser Asghari
- Clinical Research Development Center, Shahid Beheshti Hospital, Sargord Ghasemi Street, Shahid Keshvari Square, Babol, Mazandaran, Iran.
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Simultaneous gallbladder-preserving cholecystolithotomy and laparoscopic splenectomy as a surgical option for hereditary spherocytosis in a child: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared With Traditional Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2017; 26:377-380. [PMID: 27579981 PMCID: PMC5054953 DOI: 10.1097/sle.0000000000000305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The study aimed to compare the application values of endoscopic-laparoscopic cholecystolithotomy (ELC) and laparoscopic cholecystectomy (LC) for patients with cholecystolithiasis. It did a retrospective analysis of 107 patients with cholecystolithiasis who underwent ELC and 144 patients with cholecystolithiasis who underwent LC. There is no significant difference in operating time and expenses when comparing ELC with LC (P>0.05). ELC showed significantly less blood loss during operation compared with LC (P<0.01). Shortened exhaust time (P<0.05) and hospital stay (P<0.01) were present in patients who underwent ELC. Moreover, ELC showed decreased occurrence rate of dyspepsia and diarrhea in comparison with LC (P<0.01). The stone recurrence rate of ELC was 16.67%. ELC decreased the recurrence of stone in common bile duct in comparison with LC. The contractile function of gallbladder was close to normal (P<0.05), and the thickness of gallbladder wall significantly decreased (P<0.001). Patients who underwent ELC showed less digestive symptom, good recovery, and low stone recurrence compared with those who underwent LC.
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Saroj SK, Kumar S, Afaque Y, Bhartia A, Bhartia VK. The Laparoscopic Re-Exploration in the Management of the Gallbladder Remnant and the Cystic Duct Stump Calculi. J Clin Diagn Res 2016; 10:PC06-8. [PMID: 27656498 DOI: 10.7860/jcdr/2016/20154.8342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/07/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The gallbladder remnant and the cystic duct stump calculi are uncommon causes of post-cholecystectomy syndrome. Re-exploration is usually needed in the cases where symptom persists. Very few case series and reports are available regarding laparoscopic re-exploration. AIM To assess the safety and feasibility of Laparoscopic re-exploration in the cases of gallbladder remnant and cystic duct stump calculi leading to post cholecystectomy syndromes. MATERIALS AND METHODS In this study, laparoscopic re-explorations was done in 22 patients in which 17 patients had gallbladder remnant calculi and 5 had cystic duct stump calculi. The study considered parameters like the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 15 years and the data was retrospectively reviewed. RESULTS The median operating time was 83 minutes (range 51 to 134 minutes). Only one patient had conversion to open surgery. In postoperative period two patients had bile leak. They were managed conservatively and leak subsided in 8 and 11 days respectively. One patient had postoperative bleeding not requiring blood transfusion. There was no major complication requiring further intervention and no mortality. Patients were discharged on median day 4 (range 2-11) after the surgery. Patients were followed up every 3 months for one year. However, out of these three patients did not turn up for follow-up. CONCLUSION In expert hands laparoscopic re-exploration of the gallbladder remnant/cystic duct stump calculi can be performed within a reasonable operating time. The conversion to conventional re-exploration rate was very low with minimal post-operative complications and shorter hospital stay.
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Affiliation(s)
- Sanjay Kumar Saroj
- Assistant Professor, Department of Minimal Access Surgery, IMS, BHU . Varanasi, India
| | - Satendra Kumar
- Assistant Professor, Department of General Surgery, IMS, BHU , Varanasi, India
| | - Yusuf Afaque
- Senior Resident, Department of AIIMS , New Delhi, India
| | - Abhishek Bhartia
- Consultant Surgeon, Department of General Surgery, CMRI , Kolkata, West Bengal, India
| | - Vishnu Kumar Bhartia
- Consultant Surgeon, Department of General Surgery, CMRI , Kolkata, West Bengal, India
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Chowbey P, Sharma A, Goswami A, Afaque Y, Najma K, Baijal M, Soni V, Khullar R. Residual gallbladder stones after cholecystectomy: A literature review. J Minim Access Surg 2015; 11:223-30. [PMID: 26622110 PMCID: PMC4640007 DOI: 10.4103/0972-9941.158156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones.
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Affiliation(s)
- Pradeep Chowbey
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Anil Sharma
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Amit Goswami
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Yusuf Afaque
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Khoobsurat Najma
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Manish Baijal
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Vandana Soni
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Rajesh Khullar
- Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India
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Gandhi J, Tan J, Gandhi N. Gallstone pancreatitis secondary to a pathological cystic duct stump in a setting of chronic pain syndrome: a diagnostic dilemma. BMJ Case Rep 2015; 2015:bcr-2014-208917. [PMID: 25766443 DOI: 10.1136/bcr-2014-208917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 32-year-old woman presented with epigastric pain. She was a patient with chronic pain syndrome and had visited the emergency department several times over the past year. She did not drink alcohol. She had a laparoscopic cholecystectomy for gallstone pancreatitis 4 years ago. Her lipase was 2020 with normal bilirubin. MR cholangiopancreatography revealed a cystic structure resembling a gallbladder in the gallbladder fossa. This was in connection with the biliary system. The structure also contained stones. A review of the histology did confirm the gallbladder had been removed. She proceeded to have a laparoscopic re-cholecystectomy and made an unremarkable recovery.
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Affiliation(s)
- Jamish Gandhi
- Department of General Surgery and Gynaecology, Hutt Hospital, Lower Hutt, New Zealand
| | - Jeffrey Tan
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Natasha Gandhi
- Department of General Surgery, Wellington Hospital, Wellington, New Zealand
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Gao DEK, Wei SH, Li W, Ren J, Ma XM, Gu CW, Wu HR. Totally laparoscopic gallbladder-preserving surgery: A minimally invasive and favorable approach for cholelithiasis. Exp Ther Med 2014; 9:395-398. [PMID: 25574204 PMCID: PMC4280921 DOI: 10.3892/etm.2014.2107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/21/2014] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the effectiveness of laparoscopic gallbladder-preserving surgery (L-GPS) for cholelithiasis and the feasibility and value of totally laparoscopic GPS (TL-GPS). A total of 517 patients underwent L-GPS, including 365 cases of laparoscopy-assisted GPS (LA-GPS), 143 cases of TL-GPS (preservation rate, 98.3%) and nine conversions to laparoscopic cholecystectomy. The surgeries were all performed by one medical team and the mean operating time was 72 min. All macroscopic calculi were removed through endoscopy. The number of calculi observed in the patients was between one and several dozen; diameters ranged between 0.1 and 2.5 cm. Only three cases of incisional infection were noted in the LA-GPS group and long-term follow-up showed a low recurrence rate of 1.2%. L-GPS is, therefore, an excellent approach to cure cholelithiasis and TL-GPS is a feasible and effective option that could avoid incisional complications.
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Affiliation(s)
- DE-Kang Gao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Shao-Hua Wei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Wei Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Jie Ren
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Xiao-Ming Ma
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Chun-Wei Gu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Hao-Rong Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
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de Menezes HL, Fireman PA, Wanderley VE, de Menconça AMMC, Bispo RKDA, Reis MR. Randomized study for assessment of hypolipidic diet in digestive symptoms immediately following laparoscopic cholecystectomy. Rev Col Bras Cir 2014; 40:203-7. [PMID: 23912367 DOI: 10.1590/s0100-69912013000300007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/16/2012] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To validate the need for prescribing low-fat diet in the prevention or reduction of dyspeptic symptoms in the postoperative period in patients undergoing laparoscopic cholecystectomy. METHODS We selected 40 patients, free of liver or pancreatic disease, biliary gallstones, gastritis, ulcer, diabetes and dyslipidemia, who were divided into two groups. We conducted dietary anamnesis, identification of dyspepsia before the onset of cholelithiasis and guidance on appropriate postoperatively feeding (normal or low-fat). We used the chi-square test and Pearson correlation for statistical assessment, considering p d" 0.05 as significant. RESULTS When comparing the two groups of patients without preoperative dyspepsia, it was observed that in group I seven patients (63.6%) were asymptomatic and in group II, four (66.7%). In group I, four (36.4%) had onset of symptoms and in group II, two (33.3%), p = 0.684. When correlating the two groups with preoperative dyspeptic symptoms, it was observed that there was permanence, appearance or disappearance of symptoms postoperatively, p = 0.114. CONCLUSION There was no significant effect of low-fat diet in the prevention of gastrointestinal symptoms, especially in preoperatively asymptomatic patients. Thus, there is no need of a low-fat diet. So, it is up to the surgeon to evaluate each patient individually and adjust the diet to his/her needs and clinical conditions.
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Kambal A, Richards T, Jayamanne H, Sallami Z, Rasheed A, Lazim T. Instrumental detection of cystic duct stones during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2014; 13:215-8. [PMID: 24686551 DOI: 10.1016/s1499-3872(14)60034-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Residual cystic duct stones (CDSs) after cholecystectomy have been recognized as a cause of post-cholecystectomy pain. This study was undertaken to determine the incidence of CDSs during laparoscopic cholecystectomy (LC). A cohort of 330 consecutive patients (80 males and 250 females) undergoing LC between November 2006 and May 2010 was studied. Their age ranged between 16 and 88 years (median 50, IQR: 36.62). The data were prospectively collected of preoperative liver function tests, imaging, the presence of intraoperative CDSs, and common bile duct stones at on-table cholangiogram. CDSs were detected intraoperatively in 64 of the 330 patients (19%). Ultrasound failed to detect CDSs in any of these cases. Deranged liver function tests were noted in 73% of the patients with CDSs and in 57% without CDSs. Common bile duct stones were detected in 9% (29) of the 330 patients. CDSs occur commonly at routine cholecystectomy, and preoperative investigations are not helpful in their diagnosis. As CDSs may lead to postoperative morbidity, they should be actively sought out during surgery if present.
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Affiliation(s)
- Amir Kambal
- Gwent Institute for Minimal Access Surgery, Royal Gwent Hospital, Newport, NP20 2UB, United Kingdom.
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Xu B, Guan XH, Yu JX, Lv J, Zhang HX, Fu QC, Xiang HB, Bu HL, Shi D, Shu B, Qin LS, Manyande A, Tian YK. Activation of spinal phosphatidylinositol 3-kinase/protein kinase B mediates pain behavior induced by plantar incision in mice. Exp Neurol 2014; 255:71-82. [PMID: 24594219 DOI: 10.1016/j.expneurol.2014.02.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/25/2014] [Accepted: 02/18/2014] [Indexed: 12/30/2022]
Abstract
The etiology of postoperative pain may be different from antigen-induced inflammatory pain and neuropathic pain. However, central neural plasticity plays a key role in incision pain. It is also known that phosphatidylinositol 3-kinase (PI3K) and protein kinase B/Akt (PKB/Akt) are widely expressed in laminae I-IV of the spinal horn and play a critical role in spinal central sensitization. In the present study, we explored the role of PI3K and Akt in incision pain behaviors. Plantar incision induced a time-dependent activation of spinal PI3K-p110γ and Akt, while activated Akt and PI3K-p110γ were localized in spinal neurons or microglias, but not in astrocytes. Pre-treatment with PI3K inhibitors, wortmannin or LY294002 prevented the activation of Akt brought on by plantar incision in a dose-dependent manner. In addition, inhibition of spinal PI3K signaling pathway prevented pain behaviors (dose-dependent) and spinal Fos protein expression caused by plantar incision. These data demonstrated that PI3K signaling mediated pain behaviors caused by plantar incision in mice.
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Affiliation(s)
- Bing Xu
- Department of Neurology, Liuzhou Traditional Chinese Medical Hospital, the Third Affiliated Hospital of Guangxi University of Chinese Medicine, 32 Jiefang West Road, Liuzhou 545001, PR China
| | - Xue-Hai Guan
- Department of Anesthesiology, Liuzhou Traditional Chinese Medical Hospital, the Third Affiliated Hospital of Guangxi University of Chinese Medicine, 32 Jiefang West Road, Liuzhou 545001, PR China; Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China.
| | - Jun-Xiong Yu
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical College, Guilin 543001, PR China
| | - Jing Lv
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical College, Guilin 543001, PR China
| | - Hong-Xing Zhang
- The First Clinical College, China Medical University, 155 Nanjing Road, Shenyang 11001, PR China
| | - Qiao-Chu Fu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China
| | - Hong-Bing Xiang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China
| | - Hui-Lian Bu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China
| | - Dai Shi
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China
| | - Bin Shu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China
| | - Li-Sheng Qin
- Department of Anesthesiology, Liuzhou Traditional Chinese Medical Hospital, the Third Affiliated Hospital of Guangxi University of Chinese Medicine, 32 Jiefang West Road, Liuzhou 545001, PR China
| | - Anne Manyande
- School of Psychology, Social Work and Human Sciences, University of West London, London, UK
| | - Yu-Ke Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan 430030, PR China.
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Gallbladder-preserving cholelithotomy in laparoscopic and flexible choledochoscopic era: a report of 316 cases. Surg Laparosc Endosc Percutan Tech 2013; 23:167-70. [PMID: 23579512 DOI: 10.1097/sle.0b013e31828a0b5f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The gallbladder is an organ with accurate functions of concentrating and storing bile and regulating the bile flow. Cholecystectomy is associated with some severe complications in some patients. This study was to investigate the safety and effectiveness of gallbladder-preserving cholelithotomy (GPC) for patients with gallstones in laparoscopic and flexible choledochoscopic era. METHODS From January 2006 to January 2007, a total of 316 patients with gallstone were assigned to GPC according to our inclusion criteria at Yunna Lithiasis Hospital. The procedures were performed by 1 surgical team under laparoscopic and flexible choledochoscopic guidance. The short-term clinical outcome and long-term gallstone recurrence rate were evaluated. RESULTS The success rate of GPC was 95.25%. No severe postoperative complications such as bile leakage and hemorrhage occurred. Conversion to cholecystectomy was required in 15 patients. During 25 to 72 months of follow-up, the gallstone recurrence rate at 12, 36, and 60 months were 0%, 3.32%, and 5.64%, respectively. CONCLUSION GPC using laparoscopy and flexible choledochoscopy is safe and effective in selected patients, the stone recurrence rate is acceptable.
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Márquez Rojas J, Medina Ortiz JA, Martínez Mateo YA, Matito Díaz MJ, Arribas Jurado M. Cystic duct remnant syndrome: myth or reality? Cir Esp 2013; 92:496-7. [PMID: 24094928 DOI: 10.1016/j.ciresp.2013.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/20/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jesús Márquez Rojas
- Servicio de Cirugía General y Digestiva. Hospital San Pedro de Alcántara, Cáceres, España.
| | | | | | - M J Matito Díaz
- Servicio de Cirugía General y Digestiva, Hospital Infanta Cristina, Badajoz, España
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Yilmaz H, Arun O, Apiliogullari S, Acar F, Alptekin H, Calisir A, Sahin M. Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:149-153. [PMID: 24106680 PMCID: PMC3791356 DOI: 10.4174/jkss.2013.85.4.149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 06/09/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. METHODS Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. RESULTS A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). CONCLUSION In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.
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Affiliation(s)
- Huseyin Yilmaz
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Oguzhan Arun
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Seza Apiliogullari
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Fahrettin Acar
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Husnu Alptekin
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Akın Calisir
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Sahin
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
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Parmar AK, Khandelwal RG, Mathew MJ, Reddy PK. Laparoscopic completion cholecystectomy: a retrospective study of 40 cases. Asian J Endosc Surg 2013; 6:96-9. [PMID: 23280003 DOI: 10.1111/ases.12012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/15/2012] [Accepted: 11/18/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Throughout the world, laparoscopic cholecystectomy is a widely accepted surgical treatment for both acute and chronic cholecystitis. It provides total relief of pre-surgical symptoms in up to 85% of patients. However, about 5% of patients may experience severe episodes of upper abdominal pain similar to those that they had prior to cholecystectomy; this is known as post-cholecystectomy syndrome. Gallbladder remnant with calculi is one of the causative factors. However, there have been only a few case series related to this reported in literature to date. Herein, we present our experience with laparoscopic management of gallbladder remnant with calculi in 40 cases. METHODS A retrospective study of 40 cases was carried out in our institution. All patients underwent open cholecystectomy at other centres, and their cases were managed by laparoscopic completion cholecystectomy. RESULTS The mean operating time was 102.4 min (range, 60-120 min). The duration of hospital stay was 2-4 days. Two cases were converted to open surgery because of extensive dense adhesions. One case had minor a common bile duct injury, and another had port-site infection. There were no cases of mortality. CONCLUSION Gallbladder remnant containing stones may be the cause of otherwise unexplained postcholecystectomy pain. Completion cholecystectomy offers a definitive treatment for any residual gallbladder remnant and can be performed laparoscopically.
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Affiliation(s)
- Amit Kumar Parmar
- Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, India
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Issa H, Bseiso B, Almousa F, Al-Salem AH. Successful Treatment of Mirizzi's Syndrome Using SpyGlass Guided Laser Lithotripsy. Gastroenterology Res 2012; 5:162-166. [PMID: 27785198 PMCID: PMC5051085 DOI: 10.4021/gr447w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2012] [Indexed: 12/15/2022] Open
Abstract
The majority of common bile duct stones can be effectively treated by endoscopic sphincterotomy and stone extraction using basket or balloon extractor. Stones more than 2 cm in diameter on the other hand require mechanical, electrohyraulic lithotripsy and sphincterotomy and balloon dilation. Mechanical lithotripsy may not be successful because of the size, consistency and site of the stones. In these cases, laser lithotripsy is the treatment of choice. This however requires direct visualization of the stone which may not be feasible for impacted cystic duct stones. This report describes the successful treatment of difficult cystic duct stones in two patients with Mirizzi’s syndrome type I using per oral Spyglass and intraductal holmium: YAG Laser Lithotripter.
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Affiliation(s)
- Hussain Issa
- Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia and Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Bahaa Bseiso
- Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia and Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Fadel Almousa
- Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia and Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahmed H Al-Salem
- Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia and Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arabia
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El-Labban GM, Hokkam EN, El-Labban MA, Morsy K, Saadl S, Heissam KS. Intraincisional vs intraperitoneal infiltration of local anaesthetic for controlling early post-laparoscopic cholecystectomy pain. J Minim Access Surg 2011; 7:173-7. [PMID: 22022099 PMCID: PMC3193757 DOI: 10.4103/0972-9941.83508] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/22/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND: The study was designed to compare the effect of intraincisional vs intraperitoneal infiltration of levobupivacaine 0.25% on post-operative pain in laparoscopic cholecystectomy. MATERIALS AND METHODS: This randomised controlled study was carried out on 189 patients who underwent laparoscopic cholecystectomy. Group 1 was the control group and did not receive either intraperitoneal or intraincisional levobupivacaine. Group 2 was assigned to receive local infiltration (intraincisional) of 20 ml solution of levobupivacaine 0.25%, while Group 3 received 20 ml solution of levobupivacaine 0.25% intraperitoneally. Post-operative pain was recorded for 24 hours post-operatively. RESULTS: Post-operative abdominal pain was significantly lower with intraincisional infiltration of levobupivacaine 0.25% in group 2. This difference was reported from 30 minutes till 24 hours post-operatively. Right shoulder pain showed significantly lower incidence in group 2 and group 3 compared to control group. Although statistically insignificant, shoulder pain was less in group 3 than group 2. CONCLUSION: Intraincisional infiltration of levobupivacaine is more effective than intraperitoneal route in controlling post-operative abdominal pain. It decreases the need for rescue analgesia.
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Affiliation(s)
- Gouda M El-Labban
- Department of General Surgery, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, Egypt
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Abstract
UNLABELLED Unrecognized lithiasis of the cystic duct (CDL) may be responsible for post cholecystectomy. This retrospective study looked at the incidence of CDL during cholecystectomy, as well as the context of its occurrence; recommendations for a practical surgical approach are offered. PATIENTS AND METHODS Over a period of 30 months, 143 consecutive cholecystectomies (103 women, 40 men; mean age: 57 years) were performed by the same surgeon: 142 by laparoscopy, and one by laparotomy due to a history of previous gastrectomy. The cystic duct was always opened and milked upward in search of CDL before immediate clip occlusion or performance of cholangiography (106 times, 74.1%). In seven cases, cholangiography was impossible because the cystic duct was too narrow. RESULTS There was no mortality. CDL was found in 21 cases (14.7%) and removed. This had not been identified by preoperative imaging (ultrasound or CT). Pain in the month preceding cholecystectomy occurred more frequently in cases of CDL (19/21[90.4%] vs 36/122 [29.5%]; P<0.001). Similarly, liver function tests were more often abnormal with CDL (10/21 [47.6%] vs 30/122 [24.5%]; P<0.05). However, neither jaundice nor gallbladder inflammation was predictive of CDL in this study. Echoendoscopy (EUS) was performed more often for suspected common duct lithiasis migration (CBDL) in patients with CDL than for those without (9/21 [42.8%] vs 26/122 [21.3%]; P<0.05). CBDL was present in 12 of 143 patients (8.3%). This was treated by preoperative endoscopic sphincterotomy in 10 cases, and twice by trans-cystic stone extraction during the laparoscopic intervention. CBDL occurred more frequently in association with CDL (5/21 [23.8%] vs 7/122 [5.7%]; P<0.01). In addition, CDL was still present at cholecystectomy in the four patients who underwent preoperative endoscopic sphincterotomy. CONCLUSION Cystic duct lithiasis is found frequently during cholecystectomy; CDL is often associated with preoperative pain, abnormal liver function tests and choledocholithiasis. It can persist despite preoperative sphincterotomy. The search for and treatment of CDL should be routinely performed during cholecystectomy.
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Affiliation(s)
- A Sezeur
- Service de chirurgie digestive, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, Paris 75020, France.
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Skalicky M. The Size of the Papilla of Vater and Its Relation to Its Height in Comparison with the Visibility of the Sphincter of Oddi before and after Cholecystectomy. J Int Med Res 2011; 39:1039-50. [DOI: 10.1177/147323001103900339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study investigated the changes in the surface area and height of the papilla of Vater (PV) and the visibility of the sphincter of Oddi complex (SOK) using endoscopic ultrasound (EUS) examinations of 80 patients with symptomatic gallstones before and at 3 and 6 months after cholecystectomy. Following surgery, 50 patients experienced early atypical symptoms characteristic of postcholecystectomy syndrome (PCS) and 30 patients were asymptomatic. The PV measurements were greater in all patients compared with normal reference values and increased significantly from before surgery to 3 months postsurgery. At 6 months postsurgery, both the surface area and height of the PV had significantly decreased to preoperative values but remained higher than normal. The proportion of patients with a visible SOK had increased by 3 months postsurgery but had reduced again by 6 months. There were no significant differences between symptomatic and asymptomatic patients, suggesting that the changes observed in the PV and SOK do not explain the presence of the atypical symptoms of PCS.
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Affiliation(s)
- M Skalicky
- Division of Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Chowbey P, Soni V, Sharma A, Khullar R, Baijal M. Residual gallstone disease - Laparoscopic management. Indian J Surg 2010; 72:220-5. [PMID: 23133251 PMCID: PMC3452661 DOI: 10.1007/s12262-010-0058-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 12/09/2009] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A few patients who continue to suffer antecedent symptoms following laparoscopic cholecystectomy (LC) may harbor residual gallstones. The incidence of residual gallstones following cholecystectomy is <2.5%. Many of these patients require a completion cholecystectomy to ameliorate their symptoms. MATERIALS AND METHODS We reviewed our experience of laparoscopic re-intervention for residual gallstones over a period of 10 years from January 1998 to December 2007. Twenty six patients underwent Laparoscopic completion cholecystectomy (LCC) for residual gallstone disease. Twelve patients had a previous LC (2 patients - subtotal cholecystectomy) and 9 patients had a previous open cholecystectomy (7 patients - subtotal cholecystectomy). Five patients had previously undergone a cholecystostomy. Diagnostic investigations included abdominal ultrasound, endoscopic ultrasound (EUS), magnetic resonance cholangio-pancreatography (MRCP) and endoscopic retrograde cholangio-pancreatography (ERCP). RESULTS Findings included a remnant gallbladder in 3 patients, long cystic duct stump with impacted stone in 18 patients and a contracted gallbladder in 5 patients. All procedures were successfully completed laparoscopically. The mean operative time was 62 minutes and mean blood loss 50cc. Ten patient required abdominal drains postoperatively. Two patients had bilious drainage lasting 9 days and 11 days respectively. One patient died a week following surgery of acute myocardial infarction. Another patient died 6 months later of unrelated causes. The remaining patients have remained symptom free at a mean follow up of 3.2 years (range 7 months to 9 years). CONCLUSION The possibility of residual gallstones increases with subtotal cholecystectomy and inadequate dissection of the Calot's triangle in the presence of acute inflammation. Laparoscopic re-intervention for treating residual gallstone disease is feasible and can be safely performed in centers of expertise.
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Affiliation(s)
- Pradeep Chowbey
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Vandana Soni
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Anil Sharma
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Rajesh Khullar
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
| | - Manish Baijal
- Department of Metabolic and Bariatric Surgery, Institute of Minimal Access, Max Super Speciality Hospital Saket, New Delhi, India
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Abstract
Bile duct stone management has greatly changed in the past 2 decades. Open surgical techniques have mostly been replaced by transoral endoscopic techniques. Routine common bile duct stones can be managed by standard biliary endoscopic sphincterotomy and extraction. Various advanced transoral techniques can also manage most difficult ductal stones. In skilled centers, laparoscopic ductal stone management has assumed a back-up role.
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Recurrent cholecystitis and cholelithiasis in a gallbladder remnant 14 years after a converted cholecystectomy. Radiol Case Rep 2010; 5:332. [PMID: 27307843 PMCID: PMC4898219 DOI: 10.2484/rcr.v5i1.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 52-year-old man presented to the emergency department with a one-day history of epigastric pain. The patient reported a remote history of a "difficult" laparoscopic cholecystectomy that was converted to an open cholecystectomy in 1994. Further operative details were unavailable. Multiple radiologic studies were obtained, all demonstrating a saccular cystic structure in the gallbladder fossa containing calculi. A completion open cholecystectomy, or "recholecystectomy," revealed a remnant gallbladder with cholecystitis and cholelithiasis. Multimodality imaging findings are reviewed.
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Parsi MA. Peroral cholangioscopy-assisted guidewire placement for removal of impacted stones in the cystic duct remnant. World J Gastrointest Surg 2009; 1:59-61. [PMID: 21160797 PMCID: PMC2999114 DOI: 10.4240/wjgs.v1.i1.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 07/19/2009] [Accepted: 07/26/2009] [Indexed: 02/06/2023] Open
Abstract
It is well known that impacted biliary stones are difficult to remove endoscopically. Among the many factors associated with failure of endoscopic therapy for removal of bile duct stones, impaction ranks high. One of the reasons behind failure of endoscopic therapy in such cases is that the impacted stone often does not allow passage of a guidewire. Recent introduction of a novel single-operator cholangioscopy system has made it possible for a single endoscopist to use cholangioscopy for evaluation and treatment of a wide variety of biliary disorders. This cholangioscopy system was used for placement of a guidewire in the cystic duct remnant with subsequent removal of an impacted stone which had prevented passage of a guidewire by conventional means.
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Affiliation(s)
- Mansour A Parsi
- Mansour A Parsi, Center for Endoscopy and Pancreatobiliary Disorders, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States
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Pernice LM, Andreoli F. Laparoscopic treatment of stone recurrence in a gallbladder remnant: report of an additional case and literature review. J Gastrointest Surg 2009; 13:2084-91. [PMID: 19415394 DOI: 10.1007/s11605-009-0913-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 04/15/2009] [Indexed: 01/31/2023]
Abstract
Cholecystectomy is an effective treatment of gallstones. Nevertheless, recurrence of biliary symptoms following cholecystectomy, either laparotomic or laparoscopic, is quite common. Causes are either biliary or extrabiliary. Symptoms of biliary origin chiefly depend on bile duct residual stones or strictures. Rarely, they depend on stone recurrence in a gallbladder remnant. Diagnosis of gallstone recurrence in gallbladder remnant is difficult, mainly arising from ultrasonography, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography.Incomplete gallbladder removal may be either voluntary or inadvertent: in the first case, it is performed to remove gallstones without dissecting a difficult Calot's triangle or an excessively bleeding posterior wall of gallbladder caused by liver cirrhosis. Available data do not support the hypothesis that laparoscopic cholecystectomy entails an increased incidence of this condition, in spite of some opposite opinions. Treatment of lithiasis in gallbladder remnants is chiefly surgical. Although technically demanding, completion cholecystectomy can be safely performed in a laparoscopic way. We report a case of stone relapse in a gallbladder remnant, discovered 16 years following laparoscopic cholecystectomy and successfully treated by laparoscopic completion cholecystectomy. We furthermore review literature data in order to ascertain whether recent large diffusion of laparoscopic surgery causes an increase of such cases.
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Affiliation(s)
- Luigi Maria Pernice
- Department of Medical and Surgical Critical Care, Section Surgery, Florence University, Policlinico di Careggi, Viale Morgagni 85, Florence, Italy.
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Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS). Int J Surg 2009; 8:15-7. [PMID: 19857610 DOI: 10.1016/j.ijsu.2009.10.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 10/05/2009] [Accepted: 10/19/2009] [Indexed: 12/11/2022]
Abstract
The term postcholecystectomy syndrome (PCS) comprises a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. Although rare, these patients may present with abdominal pain, jaundice or dyspeptic symptoms. Many of these complaints can be attributed to complications including bile duct injury, biliary leak, biliary fistula and retained bile duct stones. Late sequelae include recurrent bile duct stones and bile duct strictures. With the number of cholecystectomies being performed increasing in the laparoscopic era the number of patients presenting with PCS is also likely to increase. We briefly explore the syndrome and its main aetiological theories.
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Affiliation(s)
- S S Jaunoo
- Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK.
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Palanivelu C, Rangarajan M, Jategaonkar PA, Madankumar MV, Anand NV. Laparoscopic management of remnant cystic duct calculi: a retrospective study. Ann R Coll Surg Engl 2008; 91:25-9. [PMID: 18990269 DOI: 10.1308/003588409x358980] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
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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Campbell-Lloyd AJM, Martin DJ, Martin IJ. Long-term outcomes after laparoscopic bile duct exploration: a 5-year follow up of 150 consecutive patients. ANZ J Surg 2008; 78:492-4. [PMID: 18522572 DOI: 10.1111/j.1445-2197.2008.04541.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The treatment of common bile duct stones discovered at routine intraoperative cholangiography includes postoperative endoscopic retrograde cholangiography or intraoperative laparoscopic common bile duct exploration. Given the equivalence of short-term outcome data for these two techniques, the choice of one over the other may be influenced by long-term follow-up data. We aimed to establish the long-term outcomes following laparoscopic common bile duct exploration and compare this with endoscopic retrograde cholangiography. METHODS One hundred and fifty consecutive patients underwent laparoscopic common bile duct exploration between March 1998 and March 2006 carried out by a single surgeon. All were prospectively studied for 1 month followed by a late-term phone questionnaire ascertaining the prevalence of adverse symptoms. Patients presented with a standardized series of questions, with reports of symptoms corroborated by review of medical records. RESULTS In 150 patients, operations included laparoscopic transcystic exploration (135), choledochotomy (10) and choledochoduodenostomy (2). At long-term follow up (mean 63 months), 116 (77.3%) patients were traceable, with 24 (20.7%) reporting an episode of pain and 18 (15.5%) had more than a single episode of pain. There was no long-term evidence of cholangitis, stricture or pancreatitis identified in any patient. CONCLUSION Laparoscopic bile duct exploration appears not to increase the incidence of long-term adverse sequelae beyond the reported prevalence of postcholecystectomy symptoms. There was no incidence of bile duct stricture, cholangitis or pancreatitis. It is a safe procedure, which obviates the need and expense of preoperative or postoperative endoscopic retrograde cholangiography in most instances.
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