Surgery, Gastroenterology and Oncology

Background: Cholecystectomy is the standard surgical option for symptomatic gallbladder disease. The symptoms persist after cholecystectomy in 10 - 20% of cases. Residual gallbladder cystic duct stump stone is one of the most important causes. This study aimed to evaluate and compare outcomes of open and laparoscopic completion cholecystectomy for gallbladder (GB) remnant stones and cystic duct stump stones as regards intraoperative and postoperative outcomes.

Methods: This study was conducted on 84 cases with residual gallbladder remnant stone or cystic duct stump stone that were divided into 2 groups, the open completion cholecystectomy group (Group A=42 cases) and the laparoscopic completion cholecystectomy group (Group B=42 cases). The diagnosis was made by ultrasound and magnetic resonance cholangio-pancreatography.

Results: Operative time (p=0.00) significantly higher at laparoscopic completion cholecystectomy and blood loss (p=0.0026) were significantly associated with open completion cholecystectomy while there was no statistically significant difference between both groups as regards intraoperative biliary injuries (p=0.56). The mean operative time was 120Â+-13 min and 160Â+-10 min in the open group and the laparoscopic group, respectively. 8 cases in the open group and 2 cases in the laparoscopic group showed intraoperative blood loss and required blood transfusion. Intraoperative biliary injuries occurred in 3 cases in the open group and 2 cases in the laparoscopic group. Conversion occurred in 4 cases in the laparoscopic group: 2 cases due to extensive adhesion, 1 case due to uncontrolled bleeding from the cystic artery, and I case from biliary leakage. Hospital stay (p=0.021), analgesic intake (p=0.00), and surgical site infection (p=0.00002) were significantly longer among the open group. There was no statistically significant difference between both groups as regards postoperative bleeding (p=0.104), while postoperative biliary leakage was (p=0.39). Intestinal injury, intra-abdominal collection, biliary stricture were (p=0.19, p=0.08, p=0.25), respectively and mortality rate was (p=0.095). Postoperative biliary leakage occurred in 6 cases in the open group and 4 cases in the laparoscopic group. Mortality occurred in 3 patients in the open group and 1 case in the laparoscopic group.

Conclusion: In expert surgery, laparoscopic re-excision of the gallbladder remnant and cystic duct stump stones can be performed within a reasonable operating time; low conversion rate; minimal post-operative complications, namely biliary leakage and bleeding; and shorter hospital stay. Trial registration at clinicaltrials.gov protocol registration quality control review criteria: NCT04329143 registered on 01 04 2020, retrospective registered.

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