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Ibrahim R, Abdalkoddus M, Mownah OA, Chanthu A, Yao L, Aroori S. Safety profile and outcomes of intraoperative ultrasound-guided remnant cholecystectomy. Ann R Coll Surg Engl 2023; 105:528-531. [PMID: 36748801 PMCID: PMC10313443 DOI: 10.1308/rcsann.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Subtotal cholecystectomy (STC) is a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study evaluates the safety profile and perioperative outcomes of remnant cholecystectomy (RC) performed under intraoperative ultrasound guidance. METHODS We retrospectively reviewed the records of all patients that underwent RC under intraoperative ultrasound guidance in 2009 and 2019. Pre-, intra- and postoperative details of patients who underwent RC were obtained from patients' electronic and paper copy records. RESULTS Ninety-seven patients underwent STC during the study period. Of this cohort, 16 patients (16.5%) presented with symptomatic gallbladder remnant over a median follow-up period of 14 months (interquartile range [IQR] 2-26). The median age was 64 years (IQR 54-69) with an equal male-to-female distribution. The median body mass index was 31kg/m2 (IQR 28-33). Twelve of 16 patients (75%) then proceeded to elective RC. Intraoperative ultrasound was used in all cases to identify the location of the remnant gallbladder and biliary anatomy. The median operative time was 88min (IQR 80-96), with 67% completed laparoscopically. No patients suffered bile duct injury. The median hospital stay was 3 days (IQR 1-5). During the follow-up period, eight patients (67%) reported symptom resolution. CONCLUSIONS RC is a safe operation that can be performed laparoscopically even after previous open subtotal cholecystectomy. We recommend the routine use of intraoperative ultrasound as an adjunct for identifying remnant gallbladder and biliary anatomy in all patients.
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Affiliation(s)
| | | | - OA Mownah
- University Hospitals Plymouth NHS Trust, UK
| | - A Chanthu
- University Hospitals Plymouth NHS Trust, UK
| | - L Yao
- University Hospitals Plymouth NHS Trust, UK
| | - S Aroori
- University Hospitals Plymouth NHS Trust, UK
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Teshima T, Nitta H, Mitsuura C, Shiraishi Y, Harada K, Shimizu K, Karashima R, Masuda T, Matsumoto K, Okino T, Takamori H. How to treat remnant cholecystitis after subtotal cholecystectomy: two case reports. Surg Case Rep 2021; 7:109. [PMID: 33939052 PMCID: PMC8093147 DOI: 10.1186/s40792-021-01183-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Subtotal cholecystectomy in patients with severe acute cholecystitis is considered a “bailout” option when the safety of the bile duct cannot be guaranteed. However, subtotal cholecystectomy has a long-term risk of remnant cholecystitis. The appropriate management of remnant cholecystitis has not been fully elucidated. Case presentation Case 1 was a 66-year-old man who had undergone subtotal cholecystectomy 14 years prior to the development of remnant cholecystitis. We first performed endoscopic gallbladder drainage to minimize inflammation, and then proceeded with elective surgery. We performed a reconstituting procedure for the residual gallbladder due to significant adhesions between the cystic and common bile ducts. Case 2 was a 56-year-old man who had undergone subtotal cholecystectomy for abscess-forming perforated cholecystitis 2 years prior to the development of remnant cholecystitis. He underwent endoscopic drainage followed by complete remnant cholecystectomy 4 months later. Conclusion Endoscopic gallbladder drainage is a useful strategy to improve inflammation and reduce the risk of bile duct injury during remnant cholecystectomy.
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Affiliation(s)
- Taisei Teshima
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan.
| | - Chisho Mitsuura
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Yuta Shiraishi
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Kazuto Harada
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Kenji Shimizu
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Ryuichi Karashima
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Katsutaka Matsumoto
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Tetsuya Okino
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Chikami, Minami-ku, Kumamoto, Japan
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