title: The Laparoscopic Re-Exploration in the Management of the Gallbladder Remnant and the Cystic Duct Stump Calculi.
abstract: BACKGROUND
  The gallbladder remnant and the cystic duct stump calculi are uncommon causes of post-cholecystectomy syndrome. Re-exploration is usually needed in the cases where symptom persists. Very few case series and reports are available regarding laparoscopic re-exploration.
  
  
  OBJECTIVE
  To assess the safety and feasibility of Laparoscopic re-exploration in the cases of gallbladder remnant and cystic duct stump calculi leading to post cholecystectomy syndromes.
  
  
  METHODS
  In this study, laparoscopic re-explorations was done in 22 patients in which 17 patients had gallbladder remnant calculi and 5 had cystic duct stump calculi. The study considered parameters like the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 15 years and the data was retrospectively reviewed.
  
  
  RESULTS
  The median operating time was 83 minutes (range 51 to 134 minutes). Only one patient had conversion to open surgery. In postoperative period two patients had bile leak. They were managed conservatively and leak subsided in 8 and 11 days respectively. One patient had postoperative bleeding not requiring blood transfusion. There was no major complication requiring further intervention and no mortality. Patients were discharged on median day 4 (range 2-11) after the surgery. Patients were followed up every 3 months for one year. However, out of these three patients did not turn up for follow-up.
  
  
  CONCLUSIONS
  In expert hands laparoscopic re-exploration of the gallbladder remnant/cystic duct stump calculi can be performed within a reasonable operating time. The conversion to conventional re-exploration rate was very low with minimal post-operative complications and shorter hospital stay.
authors.affiliation: Assistant Professor, Department of Minimal Access Surgery, IMS, BHU . Varanasi, India .
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Saroj
authors.affiliation: Assistant Professor, Department of General Surgery, IMS, BHU , Varanasi, India .
authors.forename: Satendra
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Senior Resident, Department of AIIMS , New Delhi, India .
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Afaque
authors.affiliation: Consultant Surgeon, Department of General Surgery, CMRI , Kolkata, West Bengal, India .
authors.forename: Abhishek
authors.initials: A
authors.lastname: Bhartia
authors.affiliation: Consultant Surgeon, Department of General Surgery, CMRI , Kolkata, West Bengal, India .
authors.forename: Vishnu Kumar
authors.initials: VK
authors.lastname: Bhartia
keywords: Gallstone disease; Laparoscopy; Post-cholecystectomy syndrome; Surgical intervention