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RACS ASC 2024

Resection of the Gallbladder Remnant After Subtotal Cholecystectomy: A Difficult Diagnosis and Even Harder Operation

Poster

Poster

Disciplines

HPB Surgery

Presentation Description

Institution: Department of Surgery, John Hunter Hospital - New South Wales, Australia

Purpose Emergency laparoscopic cholecystectomy frequently presents operative challenges. If a critical view of safety cannot be achieved, bail-out procedures including subtotal cholecystectomy are recommended. Known complications include remnant cholecystitis and ongoing symptoms due to gallstones. Remnant cholecystectomy is a difficult operation, with surgeons encountering hostile conditions. We describe a series of six remnant cholecystectomies performed in our institutions. Methodology Six re-do cholecystectomies for symptomatic remnant pathology were performed in our institutions in 2020-2021 and each case was reviewed for this series. Results The indication for remnant cholecystectomy in five patients was ongoing symptoms due to gallstones (three remnant cholecystitis, one cholangitis). The indication in one patient was ongoing bile leak and pain. All patients had a gallbladder remnant visible on imaging. The interval between subtotal cholecystectomy and re-do remnant cholecystectomy was three months to six years. All re-do operations were performed open, with two beginning laparoscopically before converting. Dense adhesions and challenging dissection of the remnant gallbladder were noted in all. Importantly, all managed to achieve complete remnant cholecystectomy with a critical view of safety. Conclusion Complicated disease from a remnant gallbladder can have heterogeneous presentation, and is overall an uncommon surgical problem. These cases should be approached with caution. Due to the expectation of hostile dissection and anatomical confusion we feel that this uncommon surgical problem should be approached with caution and is best dealt with in the hands of an experienced general or trained hepatobiliary surgeon.

Speakers

Authors

Authors

Dr Jett Karolewski - , Dr Nicholas Bull - , Dr Georgia Carroll - , Dr Adeeb Majid -