Laparoscopic Resection for the Treatment of Symptomatic Remnant Huge Cystic Duct with Stone after Laparoscopic Cholecystectomy

During laparoscopic cholecystectomy, the cystic duct is frequently divided closer to the gallbladder to avoid iatrogenic injury to the common bile duct. Postcholecystectomy syndrome can be considered if the patient complains of right upper abdominal discomfort after cholecystectomy. We report a case of a laparoscopic resection for the treatment of a symptomatic remnant huge cystic duct with stones after a previous laparoscopic cholecystectomy. A 46-year-old male was admitted to our hospital due to right upper quadrant abdominal pain. Five years earlier, the patient had undergone a laparoscopic cholecystectomy under the diagnosis of acute calculous cholecystitis but he subsequently suffered from intermittent right upper abdominal pain and fever. An abdominal computed tomography scan revealed a stone in a dilated remnant cystic duct. A laparoscopic remnant cystic duct resection was performed and apathologic diagnosis was made with chronic calculus cystic duct inflammation. The patient was discharged without complications and has been doing well without recurrent symptoms.

Management of stone impacted at cystic duct during laparoscopic cholecystectomy / 中国微创外科杂志

Objective To summarize our experience in the management of stones impacted at cystic duct during laparoscopic cholecystectomy(LC). Methods There were 58 patients with stones impacted at cystic duct during LC from July 1997 to June 2001.Cystic duct was incised to remove stones first,then intraoperative cholangiography was performed.If stones were found in common bile duct,they would be taken out by intraoperative endoscopic sphincterotomy or open operation. Results All the impacted stones in 58 patients were removed successfully.51 coses underwent LC.Intraoperative cholangiography showed there were common bile duct stones in 7 cases.For these 7 coses,5 cases were treated by LC combined with intraoperative endoscopic sphincterotomy and other 2 cases were converted into open operation.No Severe complication occurred. Conclusions Nearly all cases with stones impacted at cystic duct can receive LC by removing impacted stones through incising the cystic duct and intraoperative cholangiography.If there are any stones in common bile duct,they can be removed by endoscopic sphincterotomy.

Endoscopic Treatment with ESWL of Impacted Cystic Duct Stones / 대한소화기내시경학회지

BACKGROUND/AIMS: The established treatment for cystic duct stones is surgery, but nonoperative removal of gallstones through percutaneous cholecystostomy can also be a useful procedure in patients at high risk for surgery. Conventional methods using endoscopic or percutaneous stone extraction usually fail due to the inability to access or capture the cystic duct stones in the narrow, long, spiral portion of the cystic duct, especially in impacted cases. As a result stone fragmentation is required during endoscopic stone removal. It is impossible for an electrohydraulic lithotripsy (EHL) to gain access to the stones, due to the rigid distal metal tip of the lithotripter and the narrowness of the long, spiral cystic duct. Using extracorporeal shockwave lithotripsy (ESWL) to disintegrate gallstones is a more effective method for removal of cystic duct stones. Experiences of endoscopic treatment for cystic duct stones of patients with high risk for surgery were reviewed, and conclusions are included in this study. METHODS: Patient records of endoscopic management of cystic duct stones between January, 1994 and December, 1997, were reviewed for methods and results of treatment. Most of the patients had undergone lithotripsy followed by percutaneous transhepatic cholecystostomy.

Endoscopic Biliary Lithotripsy in a Patient with Gallstones of Gallbladder, Cystic Duct, and Common Bile Duct / 대한소화기내시경학회지

Endoseopic sphincterotomy(EST) has been an accepted procedure in patients with current or recurrent common bile duct stones. The success rate of sphineterotomy and of subaequent stone extraction were reported upto 90%. Percutaneous transhepatic cholecystoscopy-lithotripsy(PTCCS-L) could be one of the non-surgical treatment modalities for gallbladder stones, and has been considered as a safe, reliable and technically easy therapeutic procedure through improvement in PTCCS-L manipuiatian and through the development of new devices for this technique. PTCCS-L could be usually performed in the sgrgically high risk groups with gallbladder stones. In this report, we presented successful endoscopic biliary lithotripsy in a 60-year-old male with gallstones of gall bladder, cystic duct, and common bile duct, who was highly risk for surgery, because he has been suffered from advanced liver disease. Endoseopic sphincterotomy and stone removal with basket were done for the removal of common bile duct stones. PTCCS was performed and complete removal of gallbladder stones was achieved. Cystic duict stone was successfully removed after bougie dilation of cystic duct. There has been no recurrence of gallstones until 1 year of follow-up.