RESUMEN
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. MATERIALS AND 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. CONCLUSION: 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.
RESUMEN
PURPOSE: We present our experience with 10 patients with infected meshes after laparoscopic inguinal hernia repair in whom we explanted infected meshes laparoscopically. METHODS: On retrospective analysis over 5 years (2007 to 2012), we identified 10 patients (6 TAPP/4 TEP) with localized deep-seated mesh infections in whom infected meshes were explanted laparoscopically. Peritoneum was incised, associated abscesses were drained, meshes were identified, separated, and extracted through 10/12 mm port. RESULTS: Nine patients experienced resolution of symptoms after 3 weeks of surgical intervention and remained asymptomatic at mean follow-up of 20 months (range, 4 to 42 mo). One patient with recurrent abscess required surgical drainage twice. Mean hospital stay was 2.2 days (range, 1 to 9 d). Two patients developed recurrent hernia at 6 and 8 months after mesh explantation. CONCLUSIONS: Laparoscopic explantation of infected meshes after laparoscopic hernia repair leads to less scarring and early recovery. Contamination of anterior abdominal wall after cutaneous drainage of deep-seated abscess is avoided.