Clinical features and treatment of residual gallbladder lesions after cholecystectomy

Objective To investigate the clinical features and treatment of residual gallbladder lesions after cholecystectomy. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 83 patients with residual gallbladder lesions after cholecystectomy who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between January 2009 and April 2016 were collected. Among the 83 patients, 74 had residual gallbladder (41 combined with bile duct stones and 33 with simple residual gallbladder) and 9 had simple residual bile duct stones. Patients received laboratory and imaging examinations, and then selected suitable surgery according to residual lesions. Observation indicators included: (1) clinical features: medical history, clinical manifestation, features of laboratory and imaging examinations; (2) surgical and postoperative situations: surgical procedure, operation time, volume of intraoperative blood loss, time of drainage-tube removal, postoperative complications and duration of postoperative hospital stay; (3) postoperative pathological examination; (4) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and recurrence of lesions using abdomen color Doppler ultrasound up to October 2016. Measurement data with normal distribution were represented as ±s. Results (1) Clinical features: ① medical history: all the 83 patients had histories of cholecystectomy, including 57 with emergency operation and 26 with selective operation. ② Clinical manifestation: initial clinical manifestation occurred at 1-324 months postoperatively, with an average time of 96 months. Of 83 patients, 49 had right upper abdominal colic associated with right shoulder or back rediating pain, fever, nausea and vomiting, 24 had jaundice as the main symptoms, 8 had gradually worse conditions, with right upper quadrant abdominal pain, chills and fever associated with jaundice in the advanced stage and 2 had abdominal discomfort associated with incomplete intestinal obstruction. ③ Laboratory examination: elevated alanine transaminase (ALT) and aspartate transaminase (AST) levels were detected in 48 patients, elevated total bilirubin (TBil) level in 28 patients and elevated serum and urinary amylase level in 4 patients, respectively. ④ Imaging examination: of 83 patients, 77 had positive results of magnetic resonanced cholangio-pancreatography (MRCP), 43 had positive results of abdominal color Doppler ultrasound and 39 (4 combined with pancreatitis) had positive results of abdominal computed tomography (CT). (2) Surgical and postoperative situations: all the 83 patients underwent surgery. Of 74 patients with residual gallbladder, 72 underwent residual gallbladder resection (of 41 combined with bile duct stones, 35 undergoing residual gallbladder resection + bill duct exploration and removing the stone + T-tube drainage, 6 initially undergoing endoscopic sphincterotomy for removing bile duct stones and then residual gallbladder resection and 31 undergoing simple residual gallbladder resection), 1 combined with residual gallbladder cancer underwent residual gallbladder resection + common bile duct resection + hepatic duct-jejunum internal drainage and 1 combined with residual gallbladder cancer and common bile duct space-occupying lesion underwent palliative biliary-enterostomy. Nine patients with simple residual bile duct stones underwent endoscopic sphincterotomy for removing bile duct stones. Operation time, volume of intraoperative blood loss, time of drainage-tube removal and duration of postoperative hospital stay were (92±39)minutes, (63±12)mL, (5±4)days and (9±5)days in 74 patients with residual gallbladder, respectively. There was no severe postoperative complication. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were (57±33)minutes, (25±9)mL and (5±3)days in 9 patients with simple residual bile duct stones, respectively. No severe complication was occurred in 9 patients. (3) Postoperative pathological examination: the length of residual cystic duct in 74 patients with residual gallbladder was (2.8±1.0)cm, combining with stones. Of 74 patients, simple hyperplasia of residual gallbladder were detected in 54 patients, dysplasia in 14 patients, tumor-like hyperplasia and benign tumor in 4 patients and adenocarcinoma in 2 patients. (4) Follow-up situation: all the 83 patients were followed up for 6-71 months, with a median time of 33 months. Eighty-one patients were healthy survival, without recurrence of lesions. One patient had recurrence of bile duct stones at 34 months postoperatively, and then was cured by choledochojejunostomy, without recurrence up to the end of follow-up. One patient with residual gallbladder cancer complicated with common bile duct space-occupying lesion died at 9 months postoperatively. Conclusions Patients have recurrent right upper abdominal colic associated with right shoulder or back rediating pain, fever and jaundice after cholecystectomy, and lesions of residual gallbladder or bile duct stones should be considered. Reoperation is safe and feasible for patients, with a good clinical outcome. Key words: Remnant gallbladder; Cholelithiasis; Cholecystectomy