Management of cystic duct stone(s) during laparoscopic cholecystectomy
Keywords:Gall bladder, Laparoscopy, Cholecystectomy, Cystic duct stones
Background and objective: Although cholecystectomy relieves symptoms in the majority of cases, still a significant number of patients suffer from the post-cholecystectomy syndrome. Cystic duct remnant calculi is a causative factor of the post-cholecystectomy syndrome. Cystic duct stones are not infrequently encountered during laparoscopic cholecystectomies. This study aimed to present our experience of patients with calculi of the cystic duct that successfully dealt with laparoscopically.
Methods: This study was conducted on 4000 cases of chronic calculous cholecystitis at Rizgary Teaching Hospital from January 2010 to November 2020.
Results: Cystic duct stones were detected in 397 cases. A single stone was found within the cystic duct in 301 patients (75.8%) and multiple stones in 96 patients (24.2%). The cystic duct was reported to be wider than normal in 368 cases (92.7%) and near to normal in 29 cases (7.30%). We recorded two cases (0.5%) of concomitant common bile duct stones with cystic duct stones. Our procedure for dealing with cystic duct stone was successful in 372cases (93.7%). Milking the stone back to the gall bladder was successful in 15 cases (3.80%). In eight cases (2.00%), we were obliged to convert the procedure to open cholecystectomy. Since peroperative cholangiography and choledcoscopy are not available in our hospital, the associated common bile duct stone in two cases (0.50%) was postponed and dealt with later on. Post-operative recovery was uneventful, apart from one patient who developed features of acute cholangitis.
Conclusion: Cystic duct stones are not infrequent, as was believed earlier. Their preoperative detection may be difficult, but it can be detected easily peroperatively. Its detection and retrieval are mandatory to decrease the incidence of post-cholecystectomy phenomena.
Csikesz NG, Singula A, Murphy MM, Tseng JF, Shah SA. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci. 2010;55:2398–405. https://doi.org/10.1007/s10620-009-1035-6
Dave R, Yeomans N, Cockbain A, Toogood G. The incidence and management of cystic duct stones, the intra-operative cholangiogram is more than a diagnostic tool. Liverpool, UK: International Surgical Congress; 2012.
Perera E, Shweta B, Dogra VS. Cystic Duct Remnant Syndrome. Journal of Clinical Imaging Science. 2011;1:2. https://doi.org/10.4103/2156-7514.73500
Campagnacci R, Baldoni A, Baldorelli M, Rimini M, De Sanctis A, Di Emiddio M, et al. x
Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step? Surg Endosc. 2010;24(3):547–53. https://doi.org/10.1007/s00464-009-0599-8
Erben Y, Benavente-Chenhalls LA, Donohue JM, Que FG, Kendrick ML, Reid-Lombardo KM, et al. Diagnosis and treatment of Mirizzi syndrome: 23-year Mayo Clinic experience. J Am Coll Surg. 2013;213:114–9. https://doi.org/10.1016/j.jamcollsurg.2011.03.008
Elbalshy M, Gaber A, Ammar MS, Soltan H. Value of routine milking of cystic duct during laparoscopic cholecystectomy. Int Surg J. 2017;4(9):2889–92. https://doi.org/10.18203/2349-2902.isj20173726
Kockerling F, Schneider C, Reymond MA, Hohenberger W. Extraction Of Cystic duct occlusion calculus in laparoscopic cholecystectomy. Zentralbl Chir. 1997;122(4):295–8.
Kambal A, Richards T, Jayamanne H, Sallami Z, Rasheed A, Lazim T. Instrumental detection of cystic duct stones during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2014;13:215–8. https://doi.org/10.1016/s1499-3872(14)60034-5
Turner MA, Fulcher AS. The cystic duct: Normal anatomy and disease processes. Radiographics. 2001;21:3–22. https://doi.org/10.1148/radiographics.21.1.g01ja093
Renard Y, Sommacale D, Avisse C, Palot J-P, Kianmanesh R. Anatomia chirurgica delle vie biliari extraepatiche e della giunzione biliopancreatica. Tecniche Chirurgiche Addominali. EMC –Tecniche Chirurgiche - Addominale. 2014;20(4):1–20. https://doi.org/10.1016/S1283-0798(14)68876-8
Sezeur A, Akel K. Cystic duct remnant calculi after cholecystectomy. J Visc Surg. 2011; 148:287–90. https://doi.org/10.1016/j.jviscsurg.2011.06.001
Amir K, Richards T, Jayamanne H, Sallami Z, Rasheed A, Lazim T. Instrumental detection of cystic duct stones during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int. 2014;13:215–8. https://doi.org/10.1016/s1499-3872(14)60034-5
Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic cholecystectomy conversion rates two decades later. JSLS. 2010;14(4):476–83. https://doi.org/10.4293/ 108680810X12924466007926
Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for difficult gall bladder stone: Systemic review and meta analysis. JAMA Surg. 2015;150(2):159–68. https://doi.org/10.1001/jamasurg.2014.1219
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