title: Laparoscopic remnant cholecystectomy and transcystic common bile duct exploration for gallbladder/cystic duct remnant with stones and choledocholithiasis after cholecystectomy.
abstract: BACKGROUND
  Postcholecystectomy syndrome has been a long-standing source of frustration for surgeons. The objective of this study was to assess the feasibility and safety of laparoscopic remnant cholecystectomy (LRC) and laparoscopic transcystic common bile duct (CBD) exploration (LTCBDE) when adopted as the management for gallbladder/cystic duct remnant with stones and choledocholithiasis (GRSC) after cholecystectomy.
  
  
  METHODS
  This is a retrospective study of 11 patients who underwent surgeries for GRSC: the first 4 patients (Group 1) underwent open remnant cholecystectomy and CBD exploration, whereas the last 7 patients (Group 2) underwent LRC with LTCBDE successfully. Demographic data and perioperative parameters were analyzed and compared between the two groups.
  
  
  RESULTS
  All 11 patients had undergone cholecystectomy for symptomatic gallstone diseases. These patients had a mean age of 62 years. The time interval between cholecystectomy and the diagnosis of GRSC ranged from 4 years to 23 years (mean, 13 years). There was a significant reduction in postoperative hospital stay (5.00±1.41 versus 2.14±1.77 days, P=.034) and blood loss (35.00±10.00 versus 14.29±7.87 mL, P=.011) in Group 2 compared with Group 1. The 30-day morbidity rate was 9.1%. At a mean follow-up of 24 months (range, 6-45 months), no symptoms had recurred, and no mortality was recorded in this study.
  
  
  CONCLUSIONS
  LRC and LTCBDE for GRSC are safe and feasible and could be offered as a choice in centers performing advanced laparoscopic procedures.
authors.affiliation: Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing, People's Republic of China .
authors.forename: Jie-Gao
authors.initials: JG
authors.lastname: Zhu
authors.forename: Zhong-Tao
authors.initials: ZT
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery*; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041761:Cholecystolithiasis / Q000175:diagnosis / Q000601:surgery*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies