Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy

Abstract

Background: Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications.

Patient and methods: We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention.

Results: Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis.

Conclusion: This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.

Figure 1.

MRCP. Arrow points to the remnant gallbladder with filling defects and normal extrahepatic biliary tree.

Figure 2.

Laparoscopic view of remnant gallbladder during adhesiolysis. Black arrows denote the border of the gallbladder.

Figure 3.

Critical view of safety. The cystic duct (white arrow) and the cystic artery (black arrow) seen to be the only 2 structures entering into the remnant gallbladder with normal liver demonstrated behind them.

Figure 4.

Laparoscopic transcystic common bile duct exploration with a balloon extraction catheter in the cystic duct. The white arrow depicts the cannula in the cystic duct; the black arrow shows the remnant gallbladder.

Figure 5.

A, Gross specimen. The white solid arrow marks clips from the previous operation; the black thin arrow marks the clip on the cystic duct. B, The gross specimen, opened, demonstrating retained stones.