Surgical Management of Cystic Duct Stump Stone or Gall Bladder Remnant Stone

Kar, Abhimanyu; Gulati, Sumit; Mohammed, Sudheer; Sarala, Bhaviya Bhargavan; Ghatak, Soumya; Bhattacharyya, Avik

doi:10.1007/s12262-018-1724-5

Cited by 17 publications

(17 citation statements)

References 13 publications

(13 reference statements)

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“…Most recently, Kar et al published results on 12 patients with cystic duct and remnant gallbladder stones. While seven patients could be managed laparoscopically, five patients required conversion to an open procedure [28]. These studies demonstrate the lack of a viable minimally invasive surgical alternative for these patients.…”

Section: First Author (Year)mentioning

confidence: 89%

Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center

2022

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Background and study aims Cystic duct stones (CDS) are challenging to treat with conventional ERCP techniques due to the small diameter and tortuous nature of the cystic duct. There have been limited studies focused on endoscopic management of CDS. We present our experience managing CDS endoscopically and demonstrate that new advances in endoscopic technology have rendered CDS easier to manage. Patients and methods From 2013 to 2020, we prospectively maintained a database of patients undergoing endoscopic management of CDS. ERCP was performed in all patients, and if unsuccessful in removing stones, cholangioscopy with electrohydraulic lithotripsy (EHL) was utilized. All patients were followed in clinic for outcomes. Results Of 5,123 ERCPs performed at our institution during the study period, 21 patients were diagnosed with CDS. Six patients were successfully treated with conventional ERCP alone. Cholangioscopy with EHL was used in 15 patients undergoing 18 procedures to achieve stone clearance. CDS clearance was achieved in all patients. There was one adverse event (post-ERCP pancreatitis). Spyglass DS was associated with a significant decrease in average procedure time in comparison to first-generation SpyGlass (89.3 vs. 54.4 minutes, P = 0.004). Thirteen patients (87 %) were discharged from the hospital within 24 hours. The median follow-up duration was 23.2 months. Conclusions Endoscopy should be the preferred management strategy for CDS, especially in patients with prior cholecystectomy. Surgical outcomes have been associated with high patient morbidity and hospital length of stay. Our case series is the largest cohort of CDS patients successfully managed with cholangioscopy and EHL in the United States.

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Section: First Author (Year)mentioning

confidence: 89%

Endoscopic management of cystic duct stones and Mirizzi’s syndrome: experience at an academic medical center

2022

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“…In accordance with similar results from previously published studies, our data demonstrated that the conventional cystic duct anatomy (right lateral insertion at the mid-point between the confluence of the right/left hepatic ducts and the ampulla of Vater) was present only in fewer than 50% of our patients. Interestingly, fewer than 2% of our patients had incidental cystic duct stones [ 11 – 15 ]. These findings signify clearly that an attempt to extensively skeletonise the cystic duct during routine laparoscopic cholecystectomy is an unnecessary step and even potentially hazardous for the patient, particularly when the operation is not performed by surgeons with hepatobiliary expertise.…”

Section: Discussionmentioning

confidence: 99%

Routine extensive dissection of the cystic duct during laparoscopic cholecystectomy to reduce the risk of residual choledocholithiasis: an unnecessary step and a potentially hazardous concept

Seretis¹,

Zohdy²,

Padgett³

et al. 2022

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Introduction Post-cholecystectomy choledocholithiasis can occur from retained stones at the cystic duct stump remnant; however, most surgeons would not proceed with extensive dissection of the cystic duct during routine cholecystectomy, mainly in fear of inadvertent bile duct injuries, given the frequent anatomical variations of the extrahepatic biliary tree. Aim To determine the need and feasibility of extensive dissection of the cystic duct during laparoscopic cholecystectomy, to reduce the risk of post-cholecystectomy choledocholithiasis. Material and methods We performed a retrospective review of our institutional database of all patients who had magnetic resonance cholangiopancreatography (MRCP) prior to cholecystectomy over a 3-year period (03/2016-04/2019), assessing the anatomical variations of the cystic duct and the incidence of cystic duct stones. Results During the study period, from a total of 763 patients who underwent cholecystectomy for symptomatic gallstones, 284 had undergone pre-operative MRCP and were all included in the final analysis. The typical right lateral insertion of the cystic duct in the midpoint between the confluence of the main hepatic ducts and the ampulla of Vater was identified in less than 50% of the patients. In our series, cystic duct stones were present only in 1.8% of our patients. Conclusions The presence of significant anatomical variations and the low likelihood of incidental cystic duct stones render prophylactic extensive dissection of the cystic duct during standard laparoscopic cholecystectomy a rather unnecessary and probably hazardous step.

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“…Surgical resection of the cystic duct remnant has been the traditional approach for treatment of cystic duct remnant syndromes 2 . We report a case of cystic duct stump syndrome (stumpitis) managed solely with endoscopy.…”

Section: Figmentioning

confidence: 99%

“…On 4-week follow-up, the patient confirmed complete resolution of symptoms. Surgical resection of the cystic duct remnant has been the traditional approach for treatment of cystic duct remnant syndromes [2]. We report a case of cystic duct stump syndrome (stumpitis) mana-▶ Fig.…”

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confidence: 95%