title: Laparoscopic management of remnant cystic duct calculi: a retrospective study.
abstract: BACKGROUND
  Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from 'post-cholecystectomy syndrome'. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi.
  
  
  METHODS
  We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant.
  
  
  RESULTS
  The mean duration between first and second surgery was 8.35 months (range, 6-10.7 months). The mean operating time was 103.5 min (range, 75-132 min). Duration of hospital stay was 4-12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy - 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality.
  
  
  CONCLUSIONS
  Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. 'T'-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.
authors.affiliation: GEM Hospital and Postgraduate Institute, Ramnathapuram, Coimbatore, India. drcp@gemhospital.net
authors.forename: Chinnusamy
authors.initials: C
authors.lastname: Palanivelu
authors.forename: Muthukumaran
authors.initials: M
authors.lastname: Rangarajan
authors.forename: Priyadarshan Anand
authors.initials: PA
authors.lastname: Jategaonkar
authors.forename: Madhupalayam Velusamy
authors.initials: MV
authors.lastname: Madankumar
authors.forename: Natesan Vijay
authors.initials: NV
authors.lastname: Anand
mesh_terms: D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017562:Postcholecystectomy Syndrome / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014463:Ultrasonography