Back to the battlefield: minimally invasive management of postcholecystectomy remnants: a systematic appraisal of safety and efficacy

Postcholecystectomy syndrome (PCS) may result from either subtotal cholecystectomy or unintentional incomplete resection, leading to remnant gallbladder or residual cystic duct pathology. This scenario often presents years later, complicated by lithiasis that is not amenable to endoscopic treatment and prior surgery performed via laparotomy, typically due to difficult anatomy. Thus, reoperation becomes a technically demanding scenario, revisiting a surgical battlefield shaped by dense adhesions and distorted landmarks. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review across five databases, including studies with five or more patients undergoing laparoscopic or robotic reoperation for remnant gallbladder or cystic ducts. Data on the surgical approach, complications, conversion, and symptom resolution were collected and analyzed descriptively. Nineteen studies (443 patients) were included (407 laparoscopies and 36 robotic surgeries). The overall morbidity rate was 9.0%; conversion to open surgery occurred in 3.6% of the patients in the laparoscopic group. The robotic subgroup showed no conversions and a slightly lower morbidity (5.6%) than the laparoscopic cohort. The symptom resolution rate was 98.4%. Reoperations are often indicated after failed endoscopic retrograde cholangiopancreatography. Minimally invasive reoperation is feasible and safe in select cases of PCS, even in hostile surgical fields. Robotics offers enhanced precision and visualization and is particularly valuable in reoperative biliary surgery. Prospective studies are needed to determine optimal indications.