Best Communication By Email: azharperwaiz@gmail.com


Phone No.: 01244141414, 9871083571(6 PM to 8 PM)

Blog

  • Blog
    06 Apr

    Re-formation of gallstones after cholecystectomy “My Gallbladder (GB) has regenerated”:Fable or Fact

    35 years oldlady from Kolkata had pain right upper abdomen for the last 2 days. It reminded her of a similar episode she had experienced 4 years back for which she was diagnosed with GB stone and hence underwent its removal (cholecystectomy) at a surgical centre in Kolkata and enjoyed a comfortable life till recently. For the current pain abdomen, she was advised abdominal ultrasound which showed gallbladder stone “Again!!!”. She was surprised and with disbelief wanted a second opinion.

    MRCP confirmedresidual stump of the GB containing stone. After proper counselling she underwent laparoscopic removal of the remnant of the gallbladder containing the stone. Recovered uneventfully and was discharged after one day but the question which she kept on asking “Will it form again”thou it was well explained to her that it won’t but was bit difficult for her to believe.

    Discussion

    The entire episode listed above reminded me of a common question my patient would often ask “Doc’I have heard that the GB regenerates after surgery and stone forms again”. Sometimes an experience becomes a story popular enough to become a belief if not understood properly.

    Altered composition of bile and inadequate contraction or emptying of gallbladder are the two basic reasons as why gallstone forms. Surgical removal is the only cure. An ideal and safe cholecystectomy should remove the entire gallbladder which is only possible by ligating and dividing GB at its origin.

     

     

    In an endeavour to reduce serious injury to the CBD/bile duct (which drains bile from liver to intestine “paramount for digestion”) surgeons often avoid going too close to these structures and staying away from it may leave rim of GB stump which can be potential source stone re-formation

     

    Looking carefully, it was evident that the first surgery was difficult dueto late medical presentation and local inflammation around the bile duct. Partial cholecystectomy (i.e leaving a rim of gallbladder neck)was safest option to void injury to the CBD. Gallstone formed over the period of time in the GBremnant instead of the fact that “the gall bladder has regenerated”. Removing the entire GB remnantsafeguarding the bile duct would sufficiently guarantee against re-formation of gallstone which we could perform laparoscopically and it is almost 5 years since then “the nightmare has not returned”.

    Conclusion

    Gallbladder have no regeneration capacity. Phenomenon of gallstone formation are multi-factorial. The residual stump instead of the regenerated GB after cholecystectomy is the source of stone re-formation and surgical removal is the only cure which can be safely performed laparoscopically.  

    Categories: Gallstone

    Tags: Gallstone, Laparoscopic cholecystectomy, GB stump stone