Laparoscopic cholecystectomy is the commonly performed surgery worldwide .In experienced hands it is safe procedure but inexperience in understanding the difficult anatomy at calots and enthusiastic young surgeon who refuses for conversion to open puts patient in great trouble .Before applying clips viewing critical view of safety is of paramount importance .The incidence reported of residual gall stones is less than 2.5% in literature.

Case Report

We are reporting a case of 25 years old lady who was a case of symptomatic gallstone disease and simultaneously getting treatment for primary infertility. She underwent laparoscopic cholecystectomy that was reported to be uneventful with only inflammation in calots .The patient was discharged next day. In post operative period patient was regularly coming to OPD with complaint of pain in right hypochondrium.USG was done that revealed stone in GB fosse .Further MRCP was done which showed gall bladder remanant with stones in GB fossa region.CBD was normal. Patient was planned for relaparoscopy and proceeds, however consents were taken for conversion to open .But somehow we were lucky enough to perform it laparoscopically. There were adhesions between gall bladder remnant and omentum but separated with hydro dissection. Hydro dissection technique was used for identification of cystic duct and artery in calots and clipped separately. Patient was discharged after 2 days .She is symptom free in one year follow up period.

Conclusion

GB remnant containing stones is not the unusual cause for post cholecystectomy pain and completion cholecystectomy done ,open or laparoscopic offers definitive  treatment. Inadequate dissection in calots ,unfamiliarity with difficult calots situation, leaving long cystic duct stump to avoid inadvertent injury to CBD ,partial cholecystectomy for mirrizzi,s syndrome are few causes for post operative pain. USG and MRCP plays prudent role in investigation .These patient should be given benefit of re –laparoscopy .The emphasis on reporting this case as we were able to perform laparoscopic completion cholecystectomy