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Laparoscopic completion cholecystectomy for remnant gallbladder following previous incomplete cholecystectomy: a case series
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Electronic Poster Abstracts
EP03C-022 TIME OF CHOLELITHIASIS’ SYMPTOM OF AS A DIRECT RISK FACTOR FOR CHOLEDOCHOLITIASIS IN FEDERAL IPANEMA HOSPITAL E. Viana de Carvalho and L. Basilio Rodrigues Cirurgia Geral, Federal Hospital Ipanema, Brazil Introduction: The purpose is study the outpatients of the Federal Ipanema Hospital (HFI) with symptomatic cholelithiasis who had as choledocholitiasis complication. The HFI, hospital of “Sistema Único de Saúde” (SUS), presents in September 2015 about 800 outpatients with symptomatic cholelithiasis awaiting surgery. The long expect in line, increases the possibility of complications, whereby choledocholitiasis. It is very important stratification of these patients, applying equity. Methods: From January 2014 to August 2015, sixteen patients with choledocholitiasis were selected from the Endoscopy Unit database of HFI and one patient from the General Surgery Service database with surgery diagnosis of choledocholitiasis. It excluded from the group undergoing ERCP prior cholecystectomy patients. Results: Symptom’s time of cholelithiasis, age, sex and race of the 17 selected patients were analyzed. 70.58% of patients were aged up to 50 years, 41.17% were male and 58.82% female. The color (self-declaration): 23.52% white, 5.88% black and 47.05% brown. 23.52% were not record in database. The considered symptoms of cholelithiasis were right upper quadrant pain, vomiting and nausea. The average was 267,58 days of symptoms. Conclusion: SUS has difficulties to manage patients with cholelithiasis, without capacitance to operate all within a reasonable time. After analysis, it was found that the cholelithiasis’ symptom for more than 200 days is an independent risk factor for choledocholitiasis. It is a important data in order to stratify the patients, operating first whom is at higher risk.
EP03C-023 LAPAROSCOPIC COMPLETION CHOLECYSTECTOMY FOR REMNANT GALLBLADDER FOLLOWING PREVIOUS INCOMPLETE CHOLECYSTECTOMY: A CASE SERIES D. Daly, R. Gandy and K. S. Haghighi HPB & Transplant Surgery, University of New South Wales, Australia Introduction: Persistent upper abdominal pain following cholecystectomy has many possible causes. Recurrent cholelithiasis is a recognised outcome of subtotal cholecystectomy, in which an incomplete resection is intentionally performed due to concerns of safety of further dissection in the setting of a difficult gallbladder. A separate entity exists and remains poorly recognised, in which inadvertent incomplete resection results in a remnant gallbladder that may become recurrently symptomatic. Reported literature of this situation is very limited: we present what we believe to be the largest case series of symptomatic remnant gallbladder requiring completion surgery.
Methods: A prospectively maintained database identified 7 cases of completion cholecystectomy of a remnant gallbladder performed by a single surgeon (KH) between 2011 and 2015. Results: All 7 patients initially underwent cholecystectomy (5 laparoscopic, 2 open) for acute cholecystitis, performed by different surgeons. A difficult dissection was recognised in one case, which was described as a “near complete” open cholecystectomy. The remaining 6 cases were reported as complete and uncomplicated cholecystectomy. Subsequent laparoscopic completion cholecystectomy and intraoperative cholangiogram identified cholelithiasis in a remnant gallbladder in all 7 cases. All patients made uneventful recoveries with resolution of symptoms. Conclusions: Remnant gallbladder with associated cholelithiasis or cholecystitis is an under recognised complication of subtotal or incomplete cholecystectomy. This diagnosis should be considered in any patient with recurrent biliary symptoms following cholecystectomy. We also discuss technical pitfalls likely to predispose to remnant gallbladder, and propose standard terminology to differentiate between the complications of intentional subtotal cholecystectomy and inadvertent incomplete cholecystectomy.
Image 1. Remnant gallbladder and gallstone.
EP03C-024 APPLICATION OF A MEDICAL IMAGE THREE-DIMENSIONAL VISUALIZATION SYSTEM IN PREOPERATION PLANNING FOR INTRAHEPATIC CALCULI C. -H. Fang Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, China Introduction: This study was to evaluate a visible simulation surgery technique with a medical image threedimensional visualization system (MI-3DVS) for
HPB 2016, 18 (S1), e385ee601
Electronic Poster Abstracts
EP03C-022 TIME OF CHOLELITHIASIS’ SYMPTOM OF AS A DIRECT RISK FACTOR FOR CHOLEDOCHOLITIASIS IN FEDERAL IPANEMA HOSPITAL E. Viana de Carvalho and L. Basilio Rodrigues Cirurgia Geral, Federal Hospital Ipanema, Brazil Introduction: The purpose is study the outpatients of the Federal Ipanema Hospital (HFI) with symptomatic cholelithiasis who had as choledocholitiasis complication. The HFI, hospital of “Sistema Único de Saúde” (SUS), presents in September 2015 about 800 outpatients with symptomatic cholelithiasis awaiting surgery. The long expect in line, increases the possibility of complications, whereby choledocholitiasis. It is very important stratification of these patients, applying equity. Methods: From January 2014 to August 2015, sixteen patients with choledocholitiasis were selected from the Endoscopy Unit database of HFI and one patient from the General Surgery Service database with surgery diagnosis of choledocholitiasis. It excluded from the group undergoing ERCP prior cholecystectomy patients. Results: Symptom’s time of cholelithiasis, age, sex and race of the 17 selected patients were analyzed. 70.58% of patients were aged up to 50 years, 41.17% were male and 58.82% female. The color (self-declaration): 23.52% white, 5.88% black and 47.05% brown. 23.52% were not record in database. The considered symptoms of cholelithiasis were right upper quadrant pain, vomiting and nausea. The average was 267,58 days of symptoms. Conclusion: SUS has difficulties to manage patients with cholelithiasis, without capacitance to operate all within a reasonable time. After analysis, it was found that the cholelithiasis’ symptom for more than 200 days is an independent risk factor for choledocholitiasis. It is a important data in order to stratify the patients, operating first whom is at higher risk.
EP03C-023 LAPAROSCOPIC COMPLETION CHOLECYSTECTOMY FOR REMNANT GALLBLADDER FOLLOWING PREVIOUS INCOMPLETE CHOLECYSTECTOMY: A CASE SERIES D. Daly, R. Gandy and K. S. Haghighi HPB & Transplant Surgery, University of New South Wales, Australia Introduction: Persistent upper abdominal pain following cholecystectomy has many possible causes. Recurrent cholelithiasis is a recognised outcome of subtotal cholecystectomy, in which an incomplete resection is intentionally performed due to concerns of safety of further dissection in the setting of a difficult gallbladder. A separate entity exists and remains poorly recognised, in which inadvertent incomplete resection results in a remnant gallbladder that may become recurrently symptomatic. Reported literature of this situation is very limited: we present what we believe to be the largest case series of symptomatic remnant gallbladder requiring completion surgery.
Methods: A prospectively maintained database identified 7 cases of completion cholecystectomy of a remnant gallbladder performed by a single surgeon (KH) between 2011 and 2015. Results: All 7 patients initially underwent cholecystectomy (5 laparoscopic, 2 open) for acute cholecystitis, performed by different surgeons. A difficult dissection was recognised in one case, which was described as a “near complete” open cholecystectomy. The remaining 6 cases were reported as complete and uncomplicated cholecystectomy. Subsequent laparoscopic completion cholecystectomy and intraoperative cholangiogram identified cholelithiasis in a remnant gallbladder in all 7 cases. All patients made uneventful recoveries with resolution of symptoms. Conclusions: Remnant gallbladder with associated cholelithiasis or cholecystitis is an under recognised complication of subtotal or incomplete cholecystectomy. This diagnosis should be considered in any patient with recurrent biliary symptoms following cholecystectomy. We also discuss technical pitfalls likely to predispose to remnant gallbladder, and propose standard terminology to differentiate between the complications of intentional subtotal cholecystectomy and inadvertent incomplete cholecystectomy.
Image 1. Remnant gallbladder and gallstone.
EP03C-024 APPLICATION OF A MEDICAL IMAGE THREE-DIMENSIONAL VISUALIZATION SYSTEM IN PREOPERATION PLANNING FOR INTRAHEPATIC CALCULI C. -H. Fang Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, China Introduction: This study was to evaluate a visible simulation surgery technique with a medical image threedimensional visualization system (MI-3DVS) for
HPB 2016, 18 (S1), e385ee601