Abstract
The so-called “Postcholecystectomy Syndrome” may be due to various pathological biliary causes. The aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a long (>1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy in our patients. Three hundred and twenty two patients underwent a second operation on the bile ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking finding was a long cystic duct stump (>1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the only pathological finding. Four years after reoperation this patient is still suffering from the same intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of postcholecystectomy symptoms.
Highlights
Overall, cholecystectomy is an established successful operation which provides total relief of presurgical symptoms in up to 90% of patients
The cause of complaints in 23 patients was a pathological finding within the bile duct system (14 common bile duct stones, 6 stenosis of the sphincter of Oddi), and chronic pancreatitis in 3 patients
A pathological finding of the cystic duct stump was causative for complaints in 11 further patients (7 partial gall bladder with stones, 1 stone within the cystic duct stump, 1 fistula between cystic duct stump and duodenum, 1 suture granuloma) (Table 3)
Summary
Cholecystectomy is an established successful operation which provides total relief of presurgical symptoms in up to 90% of patients. The incidence of gastrointestinal symptoms after cholecystectomy has been reported to be between. About 5% of patients after cholecystectomy experience severe episodes of upper abdominal pain similar to those that they had prior to cholecystectomy4’5’6. The most common cause of persistent postcholecystectomy symptoms is an overlooked extrabiliary disorder (e.g. reflux esophagitis, peptic ulceration, chronic pancreatitis)7’8’9’1’1. In a small percentage of patients, a disorder of the extrahepatic bileducts may result in persistent symptoms. These so called postcholecystectomy syndromes may be due to (1) biliary strictures, (2) retained biliary calculi, (3) cystic
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