title: Residual gallbladder stones after cholecystectomy: A literature review.
abstract: BACKGROUND
  Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy.
  
  
  METHODS
  Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up.
  
  
  RESULTS
  Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct.
  
  
  CONCLUSIONS
  Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones.
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Chowbey
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Goswami
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Afaque
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Khoobsurat
authors.initials: K
authors.lastname: Najma
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.affiliation: Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
keywords: Cystic duct remnant; gallbladder remnant; post-cholecystectomy syndrome; residual gallstones; retained gallbladder stones; subtotal cholecystectomy