Completion Laparoscopic Cholecystectomy (July.2020)

Case presentation

A 55-year-old woman with a history of laparoscopic cholecystectomy presented with a complaint of recurrent pain on her upper abdomen. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed a cystic structure in the gallbladder fossa, with a multiple filling defects at midportion, suggesting a retained stones in residual gallbladder. Therefore, she underwent difficult but successful completion laparoscopic cholecystectomy.
Clinical and laboratory review for SARS – COV2 was negative. However all precautions for COVID-19 were taken during operation.
She had an uneventful postoperative period with relief of the recurrent pain.

Review of literature

International Journal of Surgery Case Reports Volume 42, 2018, Pages 145-14
Post cholecystectomy syndrome need to redo laparoscopic completion surgery: A case report Ali Zahedian, Sekineh Kamali Ahangar, Yasser Asghari

Abstract

Introduction
Cholecystectomy is the standard treatment for symptomatic gallbladder stone disease. However, symptoms such as abdominal pain and dyspepsia may persist even after surgery, if the gallbladder is incompletely removed known as postcholecystectomy syndrome.

Case presentation

A 55-year-old man with a history of open cholecystectomy presented with a complaint of recurrent pain on his upper abdomen. Abdominal ultrasonography and magnetic resonance cholangiopancreatography revealed a cystic structure in the gallbladder fossa, with a filling defect at the midpoint of the cystic duct, suggesting a retained stone in the cystic duct and residual gallbladder. Therefore, he underwent completion laparoscopic cholecystectomy. He had an uneventful postoperative period with relief of the recurrent pain.

Discussion

Proper dissection and identification of the gallbladder and cystic duct junction is necessary for complete removal of the gallbladder and preventing postcholecystectomy syndrome. Patients with a retained stone in the residual gallbladder should undergo surgery, and the laparoscopic method can be performed by a surgeon with expertise in this revision surgery.

Conclusion

In post-cholecystectomy syndrome, symptomatic Patients with retained stone in partially removed gall bladder by open method needs laparoscopic cholecystectomy by an expert surgeon to relieve their symptoms.