Management of cystic duct stone(s) during laparoscopic cholecystectomy

Abstract

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. Keywords: Gall bladder; Laparoscopy; Cholecystectomy; Cystic duct stones.