Successful laparoscopic cholecystectomy for giant gallstone using a ‘double-bag' technique in an obese patient

Introduction

We describe a case of successful laparoscopic cholecystectomy using a “double bag technique" to retrieve giant gall stone. Laparoscopic removal of gallstones within the gallbladder, larger than 5cm have rarely been reported in the literature.

Case description

A 44 year old woman presented to the outpatient surgical clinic with symptomatic gallstones. She otherwise had no other medical problems. However, her BMI was 40.9.

Results and Conclusions

Blood tests were within the normal range. Her ultrasound scan report showed ‘many gallstones within the body of the gallbladder, the largest approximately 1cm’. During her laparoscopic cholecystectomy, a very large, 8cm gallstone was encountered in the fundus of the gallbladder.

The gallbladder wall was opened and the stone extracted and placed in the right paracolic gutter, adjacent to the liver. A standard laparoscopic cholecystectomy was then performed. The gallbladder and the ‘giant stone’ were extracted separately. The former via “Bert^TM bag” 80ml capacity and latter via the “Anchor^TM tissue retrieval system device TRS100SB2” 235ml capacity – using the “pack and push the envelope” technique.

Take home message

This case highlights that it is possible to retrieve a giant stone laparoscopically, without the need to convert to open procedure, using the above technique. It is important for the surgeon to be familiar with the various tissue retrieval systems available.