Can gallstones still form after a cholecystectomy (chole)

From the Guidelines

Yes, you can still get gallstones after a cholecystectomy, although the risk is significantly lower if the gallbladder is empty following duct clearance. According to a high-quality study published in Gut in 2017 1, the reported incidence of recurrent common bile duct stones (CBDS) was 5.9% to 11.3% in patients with an empty gallbladder, which is significantly lower than those with residual gallbladder stones. The study suggests that cholecystectomy is recommended for all patients with CBDS and gallbladder stones, unless there are specific reasons for considering surgery inappropriate. Some key points to consider include:

• The risk of recurrent CBDS is lower in patients with an empty gallbladder
• Patients with an empty gallbladder have a lower risk of cholecystitis and subsequent cholecystectomy
• Uncertainty persists as to whether the recommendation to offer cholecystectomy to patients with gallbladder stones and CBDS should be extended to individuals with CBDS but an empty gallbladder on imaging. It's essential to maintain a healthy diet, stay hydrated, and attend regular follow-up appointments after surgery to reduce the risk of developing gallstones. If symptoms such as upper abdominal pain, jaundice, fever, and digestive issues occur after cholecystectomy, seek medical attention promptly, as treatment typically involves endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove stones from the bile ducts 1.

From the Research

Residual Gallstones after Cholecystectomy

• Residual gallstones can occur after a cholecystectomy, as seen in studies 2, 3, 4
• The commonest presentation of residual gallstones is abdominal pain, dyspepsia, and jaundice 3
• Residual gallstones can be found in the gallbladder remnant, cystic duct remnant, or common bile duct 3, 4

Causes of Residual Gallstones

• Incomplete gallbladder removal following open and laparoscopic techniques can lead to residual gallstones 3
• Subtotal cholecystectomy and remnant cystic duct stump stone are causes of postcholecystectomy syndrome that can lead to residual gallstones 2
• Clip migration in the common bile duct can also cause obstructive jaundice and stone formation 5

Treatment of Residual Gallstones

• Laparoscopic surgery is a preferred treatment modality for residual gallstones, but requires an experienced surgeon in advanced laparoscopic techniques 2, 4
• Endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP), can also be used to manage residual gallstones 5, 6, 4
• Open surgery may be necessary in some cases, such as when laparoscopic surgery is not possible or has failed 6, 4

Outcomes of Treatment

• Studies have shown favorable outcomes in patients undergoing laparoscopic intervention for retained gallstones, with low complication rates and high success rates 2, 4
• The choice of treatment modality depends on the location and number of residual gallstones, as well as the patient's overall health and medical history 3, 6, 4