Instrumental detection of cystic duct stones during laparoscopic cholecystectomy

Kambal, Amir; Richards, Tomos; Jayamanne, H; Sallami, Zeyed; Rasheed, Ashraf; Lazim, Taha

doi:10.1016/s1499-3872(14)60034-5

Cited by 5 publications

(4 citation statements)

References 16 publications

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“…10 In our study there was recent onset of mild transient liver function tests (LFTs) derangement associated with right hypochondrial pain in about 67.8% of patients who revealed to have CDS, and this was significantly higher in comparison to those who don't have CDS. This is consistent with the findings of Sezeur and Akel, where LFTs were deranged more commonly in association with CDS (47.6% versus 24.5%; P<0.05).…”

mentioning

confidence: 60%

“…6 In another study published by Kambal A and others in 2014 stated that the incidence of cystic duct stones was about 19%. 10 Also a prospective study from St James University Hospital (Leeds, UK), presented in 2012 at the international conference of the Association of Surgeon of Great Britain and Ireland found sludge or CDS shown on OTC during LC at an incidence of 20%.…”

Section: Discussionmentioning

confidence: 99%

“…6 Also in the study of Kambal A and others they documented that the incidence was more common when CDS was present (50% versus 29%). 10 From the previous we can say CDSs are not rare and careful milking of the cystic duct before applying clips is a safe and effective way for detecting and extracting these stones even if they were not detected preoperatively. This simple maneuver may reduce the rate of post-cholecystectomy pain in addition of giving us a notice of more serious condition of CBD stones and raise our need to do intra-operative cholangiography.…”

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confidence: 97%

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Value of routine milking of cystic duct during laparoscopic cholecystectomy

et al. 2017

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Background: Cystic duct stones (CDS) although they are occasionally encountered during laparoscopic cholecystectomy (LC) and are not detected easily by preoperative investigations however it is worthy to detect them intra-operatively as they will decrease the incidence of postcholecystectomy pain and they will alarm us to the more serious common bile duct (CBD) stones. So, we aimed at this study to evaluate the role of cystic duct milking in detection of cystic duct stones and its significance.Methods: This study was performed on 150 cases with calcular cholecystitis at Menofia University hospital in the period from August 2015 to May 2017. All patients had undergone LC, cystic duct milking. On table cholangiogram was done for cases that showed CDS.Results: CDS were detected in 28 cases, preoperative investigations failed to detect any of them however retrospectively 19 cases (67.8%) of them revealed to have mild transient liver functions derangement associated with acute right hypochondrial pain. Wide cystic duct (more than 4 mm) was recorded in 3 cases (10.7%) out of 28 cases that showed CDS. The incidence of association of cystic duct stones and CBD stones was found in 10 cases (35.7%).Conclusions: CDS are occasionally encountered during LC. They can be removed easily by just milking of cystic duct before clipping. The benefit is to decrease the incidence of post-cholecystectomy pain as well as it alerts us towards the more serious CBD stones. So on-table cholangiogram at that time becomes mandatory to avoid missed stone.

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confidence: 60%

Section: Discussionmentioning

confidence: 99%

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confidence: 97%

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Value of routine milking of cystic duct during laparoscopic cholecystectomy

et al. 2017

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“…The sensitivity of ultrasound to diagnose gallbladder neck or CD stones is low, in one study ultrasound failed to detect any of the 64 patients with CD stones. 10 MRCP, on the other hand, has a higher sensitivity for detecting the location of stones in the biliary tree of 85%. 11 In this series, preoperative MRCP was not commonly employed.…”

Section: Preoperative Imagingmentioning

confidence: 99%

Hartmann's Pouch Stones and Laparoscopic Cholecystectomy: The Challenges and the Solutions

Khan

Sajid

McMahon

et al. 2020

JSLS

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Background & Objective: Hartmann's pouch stones (HPS) encountered during laparoscopic cholecystectomy (LC) may hinder safe dissection of the cystic pedicle or be complicated by mucocele, empyema, or Mirizzi syndrome; distorting the anatomy and increasing the risk of bile duct injury. We studied the incidence, presentations, operative challenges, and outcomes of HPS. Methods: A cohort study of a prospectively maintained database of LCs and bile duct explorations performed by a single surgeon. Patients were divided into two groups: those with HPS and those without. Patients' demographics, clinical presentation, intra-operative findings, and postoperative outcomes were compared. Results: Of the 5136 patients, 612 (11.9%) had HPS. The HPS group were more likely to present with acute cholecystitis (27.9% vs 5.9%, P ϭ .000) and more patients underwent emergency LC (50.7% vs 41.5%, P ϭ .000). The HPS group had more difficult cholecystectomies, with 46.1% vs 11.8% in the non-HPS group being operative difficulty grade 4 and 5. Mucocele, empyema, and Mirizzi syndrome were more common in the HPS group (24.0% vs 3.7% P ϭ .000, 30.9% vs 3.7% P ϭ .000, 1.8% vs 0.9% P ϭ .000, respectively). There was no significant difference in the open conversion rate or complications. Conclusion: HPS increase the difficulty of LC. Surgeons should be aware of their presence and should employ appropriate dissection strategies. Sharp or diathermy dissection should be avoided. Dislodging the stone into the gall bladder, stone removal, swab dissection, and cholangiography are useful measures to avoid ductal injury and reduce the conversion rate.

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