MANAGEMENT OF RECURRENT CALCULAR GALL BLADDER AFTER CHOLECYSTECTOMY, A SURGICAL DILEMMA

Abstract

Background: Gallstones with symptoms are often treated with a cholecystectomy. Postcholecystectomy syndrome is defined by the continued presence of symptoms after surgery. Subtotal cholecystectomy, residual cystic duct stump stone, hourglass gall bladder, and double gall bladder are some of the biliary causes of postcholecystectomy syndrome. These causes are uncommon, but they necessitate identification and provocation therapy. Such patients could be managed laparoscopically; however, this requires laparoscopic surgical teams with the necessary skills.Materials and Methods:This study is a retrospective analysis of patients who were admitted to the Surgery Department of TBRI Hospital and other private hospitals that required laparoscopic surgery for residual gallbladder, cystic duct stump stone, hourglass gall bladder, and double gall bladder.Results:Between 2021 and 2023, 22 patients were hospitalized with residual gallbladder, cystic duct stump stones, hourglass gall bladders, and double gall bladders that required surgery. All patients underwent a complete cholecystectomy. Symptomatology was dominated by recurrent biliary colic (100%), while fever occurred in 9 (40%) patients. The period between the primary surgery and the surgery to complete the resection varied between 2-22 years. Duodenal injury was encountered in only one case (7.14%), and one patient had a CBD injury after ERCP and was managed laparoscopically. The average number of days of hospitalization was three. No patient showed any symptoms at the 6-month postoperative follow-up.Conclusions: The causes of postcholecystectomy syndrome include residual gallbladder/cystic duct stump stones, hourglass gallbladders, and double gallbladders. Patients with symptoms who need surgery are challenging to manage. Although laparoscopic surgery is favored, it demands a skilled surgeon who is competent in laparoscopic procedures.