Reoperation After Cholecystectomy. TheRole of the Cystic Duct Stump

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.

Laparoscopic Completion Cholecystectomy for Post Cholecystectomy Syndrome

“…It could be concluded that the presence of a long cystic duct stump or a gallbladder remnant (With or without calculi) on investigation, in patients with persistent post-cholecystectomy symptoms definitely demands surgical intervention, especially when a stone is present. [1,[9][10][11][12] We could not come across any reports about the outcomes of conservative management of patients with postcholecystectomy remnant and persistent symptoms. One of our patients was managed with completion cholecystectomy after clearance of CBD calculi by ERCP.…”

“…1,[10][11][12][13][14] These patients can remain asymptomatic, 1,13,14 or they can present with acute symptoms (biliary colic, acute cholecystitis or acute pancreatitis) or chronic symptoms (persistent right upper quadrant discomfort or pain, food intolerance, nausea or jaundice). 1,[8][9][10][11][12][13][14] Although there are no pathognomic symptoms, the persistence of symptoms after cholecystectomy should alert the clinician to the possibility of a gallbladder remnant, especially when coupled with radiation of pain to the shoulder, food intolerance, nausea or jaundice. 1,15 Similarly, the timing of presentation is also very variable, with patients presenting at any time between less than 1 year and up to 25 years after cholecystectomy.…”

Post Cholecystectomy Stump Calculus Cholecystitis with Completion Cholecystectomy –A Rare Case Report

“…It is not clear from the existing literature as to what is the natural history of these gallbladder remnants over a period of time, but there seems to be a trend towards surgical intervention in symptomatic patients. It could be concluded that the presence of a long cystic duct stump or a gallbladder remnant (with or without calculi) on investigation, in patients with persistent post-cholecystectomy symptoms definitely demands surgical intervention, especially when a stone is present [13,14,15] . Patients with gall bladder remnant can be asymptomatic or they can present with acute symptoms (biliary colic, acute cholecystitis or acute pancreatitis) or chronic symptoms (persistent right upper quadrant discomfort or pain, food intolerance, nausea or jaundice) [16] .…”

Presentation and management of gallbladder remnant after partial cholecystectomy

“…The presentation of a gallbladder remnant can be variable not only in terms of clinical features, but also in relation to the time interval after cholecystectomy. 1,[10][11][12][13][14] These patients can remain asymptomatic, 1,13,14 or they can present with acute symptoms (biliary colic, acute cholecystitis or acute pancreatitis)…”

“…1,[8][9][10][11][12][13][14] Although there are no pathognomic symptoms, the persistence of symptoms after cholecystectomy should alert the clinician to the possibility of a gallbladder remnant, especially when coupled with radiation of pain to the shoulder, food intolerance, nausea or jaundice. 1,15 Similarly, the timing of presentation is also very variable, with patients presenting at any time between less than 1 year and upto 25 years after cholecystectomy.…”