Incidence and management of cystic duct stones

Dushyant Kumar Garg; Aabid Hassan Naik; Showkat Nazir Wani; Nikhil Mahajan; Jashanpreet K Virk

Volume : IX, Issue : III, March - 2019

Incidence and management of cystic duct stones

Dushyant Kumar Garg, Aabid Hassan Naik, Showkat Nazir Wani, Nikhil Mahajan, Jashanpreet K Virk

Abstract :

Background: laproscopic cholecystectomy represents a significant change in the management of GB disease and is gold standard treatment for symptomatic cholelithiasis. However some 15–20% of patients continue to have postcholecystectomy syndromes, the causes of which are diverse. One important such cause is cystic duct stones which are usually missed intraopertively. Focused attention towards same with some intraoperative maneuvers would help to reduce their contribution to PCS. Methods: The study was carried over 3 years from 2014–2016 during which 743 LC were studied. Patients detected to have cystic duct stones by noting abnormal bulge, adhesions or non uniformity of duct were subjected to different intraoperative maneuvers like milking of duct, complete dissection of CD–CBD junction and ligation of CD close to CBD were utilised Results: We found cystic duct stones in 87(11.7%) out of 743 Laproscopic cholecystectomies performed. Upon follow up we found that out of 87 patients of detected cystic duct stones, 84(96.5%) patients had no complaints postoperatively upto 2 years while as 2(2.2%) patients had CBD stones (both of them were patients of Mirrizi’s syndrome) and one patient had retained cystic duct stone even after milking of the stone to Gall bladder. Conclusion: We conclude that the incidence of CD stones is underestimated as well as under reported, which is a significant cause of PCS. However if attention is given to CD during Laproscopic cholecystectomy and exploiting some simple and safe maneuvers, they can be effectively dealt with reducing PCS. Methods: The study was carried over 3 years from 2014–2016 during which 743 LC were studied. Patients detected to have cystic duct stones by noting abnormal bulge, adhesions or non uniformity of duct were subjected to different intraoperative maneuvers like milking of duct, complete dissection of CD–CBD junction and ligation of CD close to CBD were utilised Results: We found cystic duct stones in 87(11.7%) out of 743 Laproscopic cholecystectomies performed. Upon follow up we found that out of 87 patients of detected cystic duct stones, 84(96.5%) patients had no complaints postoperatively upto 2 years while as 2(2.2%) patients had CBD stones (both of them were patients of Mirrizi’s syndrome) and one patient had retained cystic duct stone even after milking of the stone to Gall bladder. Conclusion: We conclude that the incidence of CD stones is underestimated as well as under reported, which is a significant cause of PCS. However if attention is given to CD during Laproscopic cholecystectomy and exploiting some simple and safe maneuvers, they can be effectively dealt with reducing PCS