Completion cholecystectomy for remnant gall bladder stones: A tertiary centre experience

Abstract Introduction: Remnant gall bladder and cystic duct stump calculi are uncommon but significant causes of post-cholecystectomy syndrome, often presenting after a prolonged interval and posing diagnostic and technical challenges. Evidence from contemporary Indian cohorts remains limited and heterogeneous. Patients and Methods: This retrospective observational study analysed 22 consecutive patients who underwent completion cholecystectomy for symptomatic remnant gall bladder or cystic duct stump calculi between January 2015 and December 2024 at a tertiary referral centre. Patients with radiologically confirmed remnant pathology and prior sub-total or difficult cholecystectomy were included. Clinical, imaging, operative, perioperative and follow-up outcomes were analysed. Results: The mean age was 47.8 years with female predominance (77.2%). The median interval between index surgery and symptom onset was 4 years. Biliary colic was the most common presentation (86.4%), with complications in 18.2% of patients. Ultrasonography detected pathology in 76%, whereas magnetic resonance cholangiopancreatography (MRCP) demonstrated 100% diagnostic accuracy. Laparoscopic completion cholecystectomy was successfully performed in 86.4% of patients, with a conversion rate of 9%. The mean operative duration was 118 min, and the mean blood loss was 87 ml. Critical view of safety was achieved in 50% of cases. Post-operative complications (Clavien–Dindo >II) occurred in 13.6% of patients, with no mortality. The median hospital stay was 2 days. At a median follow-up of 26 months, all patients achieved complete relief of biliary pain, although 35% of patients reported mild dyspeptic symptoms. Conclusions: Completion cholecystectomy is a safe and effective definitive treatment for remnant gall bladder and cystic duct stump calculi, with high laparoscopic feasibility and favourable outcomes in experienced hands. MRCP plays a crucial role in diagnosis and operative planning, while redo surgery remains technically demanding due to altered anatomy.