Benea I, Fabbri N, Pesce A, Feo CV. Indocyanine green-guided laparoscopic completion cholecystectomy for stump syndrome: A case report. World J Clin Cases 2026; 14(23): 121732 [DOI: 10.12998/wjcc.121732]
Corresponding Author of This Article
Nicolò Fabbri, MD, Unit of General Surgery, AUSL Ferrara, Via Valle Oppio 2 Ferrara, Lagosanto 44023, Ferrara, Italy. n.fabbri@ausl.fe.it
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Surgery
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case-report
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Benea I, Fabbri N, Pesce A, Feo CV. Indocyanine green-guided laparoscopic completion cholecystectomy for stump syndrome: A case report. World J Clin Cases 2026; 14(23): 121732 [DOI: 10.12998/wjcc.121732]
World J Clin Cases. Aug 16, 2026; 14(23): 121732 Published online Aug 16, 2026. doi: 10.12998/wjcc.121732
Indocyanine green-guided laparoscopic completion cholecystectomy for stump syndrome: A case report
Isotta Benea, Nicolò Fabbri, Antonio Pesce, Carlo V Feo
Isotta Benea, Department of Medical Sciences, University of Ferrara, Ferrara 44100, Emilia-Romagna, Italy
Nicolò Fabbri, Antonio Pesce, Unit of General Surgery, AUSL Ferrara, Lagosanto 44023, Ferrara, Italy
Carlo V Feo, Unit of General Surgery, Local Health Agency of Ferrara, Ferrara 44100, Emilia-Romagna, Italy
Co-first authors: Isotta Benea and Nicolò Fabbri.
Author contributions: Benea I and Fabbri N designed the research study; Benea I, Fabbri N, and Pesce A performed the research; Benea I and Fabbri N analyzed the data and drafted the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: Portions of this manuscript were edited using artificial intelligence (AI) tools for language refinement. The authors take full responsibility for the scientific content of the manuscript, and agree to be accountable for all aspects of the work.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Nicolò Fabbri, MD, Unit of General Surgery, AUSL Ferrara, Via Valle Oppio 2 Ferrara, Lagosanto 44023, Ferrara, Italy. n.fabbri@ausl.fe.it
Received: March 31, 2026 Revised: May 30, 2026 Accepted: June 29, 2026 Published online: August 16, 2026 Processing time: 134 Days and 8.8 Hours
Abstract
BACKGROUND
Gallbladder remnant disease is an uncommon late complication after subtotal cholecystectomy (SC). Reoperation may be difficult because inflammation and adhesions can obscure the biliary anatomy. This case describes the practical value of indocyanine green (ICG) fluorescence during laparoscopic completion cholecystectomy in a complex reoperative setting.
CASE SUMMARY
A 63-year-old man had previously undergone SC because Calot’s triangle could not be safely dissected. Owing to severe inflammation and unsafe Calot’s triangle anatomy, a reconstituting SC was performed. Two years later, he presented with abdominal pain, dark urine, and mild hyperamylasemia. Computed tomography and magnetic resonance cholangiopancreatography demonstrated microlithiasis within the cystic duct stump, local inflammatory changes, and an anomalous cystic duct, with no stones in the common bile duct. Elective laparoscopic completion cholecystectomy was performed after intravenous ICG administration 45 minutes before surgery. Fluorescence imaging clarified the relationship between the remnant, cystic duct, and common bile duct, allowing safe laparoscopic dissection. Recovery was uneventful, and the patient was discharged on postoperative day 1.
CONCLUSION
ICG fluorescence can be a useful adjunct during laparoscopic completion cholecystectomy in selected patients with gallbladder remnant disease.
Core Tip: Subtotal cholecystectomy is a valuable bailout strategy in difficult gallbladder surgery but carries a risk of residual stump-related complications. This case highlights that laparoscopic completion cholecystectomy is feasible and safe, even in reoperative settings. Indocyanine green fluorescence imaging enhances visualization of the biliary anatomy, facilitating safer dissection and achievement of the critical view of safety. Its use may reduce operative risk and should be considered in selected complex cases.
