title: Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy.
abstract: BACKGROUND
  Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications.
  
  
  METHODS
  We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention.
  
  
  RESULTS
  Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis.
  
  
  CONCLUSIONS
  This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA. krohm@ccf.org
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
mesh_terms: D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*