{"title":"残余胆囊结石的腹腔镜治疗：一家三级医疗中心的经验之谈","authors":"Gilbert Samuel Jebakumar , Jeevanandham Muthiah , Loganathan Jayapal , R. Santhosh Kumar , Siddhesh Tasgaonkar , K.S. Santhosh Anand , J.K.A. Jameel , Sudeepta Kumar Swain , K.J. Raghunath , Prasanna Kumar Reddy , Tirupporur Govindaswamy Balachandar","doi":"10.1016/j.lers.2024.02.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease. Despite its success, approximately 10% of patients may experience persistent biliary symptoms, leading to the post-cholecystectomy syndrome. A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome. The objective of this study was to shed light on the clinical manifestations, evaluation, therapeutic strategies, and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.</p></div><div><h3>Methods</h3><p>This was a retrospective study, conducted over a five-year period (January 2017 to December 2022) at Apollo Hospitals in South India. All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included. The following data were collected: patient demographics, symptoms, preoperative investigations, intraoperative details and post operative outcomes.</p></div><div><h3>Results</h3><p>In total, 36 patients were included and analysed. The majority of patients were male (25, 69.4%), with a mean age of 50.7 ± 12.1 years. The most common presentation was pain in the upper abdomen or right upper quadrant region (24, 66.7%). The laparoscopic approach was attempted in all patients, with a success rate of 94.4%. Two patients required conversion to open surgery. Cholecystoenteric fistula to the colon was observed in one patient. Choledocholithiasis was observed in 7 patients (19.4%), and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.</p></div><div><h3>Conclusion</h3><p>Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection. Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy, a complex procedure associated with certain risks. This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"7 1","pages":"Pages 27-33"},"PeriodicalIF":0.0000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468900924000057/pdfft?md5=23b0760e83b6e8170dda363435505da5&pid=1-s2.0-S2468900924000057-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience\",\"authors\":\"Gilbert Samuel Jebakumar , Jeevanandham Muthiah , Loganathan Jayapal , R. Santhosh Kumar , Siddhesh Tasgaonkar , K.S. Santhosh Anand , J.K.A. Jameel , Sudeepta Kumar Swain , K.J. Raghunath , Prasanna Kumar Reddy , Tirupporur Govindaswamy Balachandar\",\"doi\":\"10.1016/j.lers.2024.02.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease. Despite its success, approximately 10% of patients may experience persistent biliary symptoms, leading to the post-cholecystectomy syndrome. A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome. The objective of this study was to shed light on the clinical manifestations, evaluation, therapeutic strategies, and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.</p></div><div><h3>Methods</h3><p>This was a retrospective study, conducted over a five-year period (January 2017 to December 2022) at Apollo Hospitals in South India. All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included. The following data were collected: patient demographics, symptoms, preoperative investigations, intraoperative details and post operative outcomes.</p></div><div><h3>Results</h3><p>In total, 36 patients were included and analysed. The majority of patients were male (25, 69.4%), with a mean age of 50.7 ± 12.1 years. The most common presentation was pain in the upper abdomen or right upper quadrant region (24, 66.7%). The laparoscopic approach was attempted in all patients, with a success rate of 94.4%. Two patients required conversion to open surgery. Cholecystoenteric fistula to the colon was observed in one patient. Choledocholithiasis was observed in 7 patients (19.4%), and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.</p></div><div><h3>Conclusion</h3><p>Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection. Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy, a complex procedure associated with certain risks. This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.</p></div>\",\"PeriodicalId\":32893,\"journal\":{\"name\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"volume\":\"7 1\",\"pages\":\"Pages 27-33\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2468900924000057/pdfft?md5=23b0760e83b6e8170dda363435505da5&pid=1-s2.0-S2468900924000057-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468900924000057\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laparoscopic Endoscopic and Robotic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468900924000057","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience
Objective
Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease. Despite its success, approximately 10% of patients may experience persistent biliary symptoms, leading to the post-cholecystectomy syndrome. A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome. The objective of this study was to shed light on the clinical manifestations, evaluation, therapeutic strategies, and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.
Methods
This was a retrospective study, conducted over a five-year period (January 2017 to December 2022) at Apollo Hospitals in South India. All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included. The following data were collected: patient demographics, symptoms, preoperative investigations, intraoperative details and post operative outcomes.
Results
In total, 36 patients were included and analysed. The majority of patients were male (25, 69.4%), with a mean age of 50.7 ± 12.1 years. The most common presentation was pain in the upper abdomen or right upper quadrant region (24, 66.7%). The laparoscopic approach was attempted in all patients, with a success rate of 94.4%. Two patients required conversion to open surgery. Cholecystoenteric fistula to the colon was observed in one patient. Choledocholithiasis was observed in 7 patients (19.4%), and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.
Conclusion
Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection. Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy, a complex procedure associated with certain risks. This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.
期刊介绍：
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.
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