title: Surgical and endoscopic management of remnant cystic duct lithiasis after cholecystectomy--a case series.
abstract: BACKGROUND
  Postcholecystectomy syndrome (PCS) as a result of remnant cystic duct lithiasis (RCDL), or gallstones within the cystic duct after cholecystectomy, can cause persistent or recurrent symptoms after cholecystectomy.
  
  
  METHODS
  A retrospective descriptive analysis was performed for all patients with RDCL at a single institution between 2001 and 2012. Details of presentation, diagnosis, and surgical and endoscopic treatments, and outcomes were collected and analyzed.
  
  
  RESULTS
  Twelve patients with RCDL were identified. The interval between cholecystectomy to RCDL discovery was 34.2 months (range 0.5-168 months). On a standard liver enzyme panel, 75% of patients had derangements in ≥1 indices, with the most common single laboratory test abnormality occurring in gamma-glutamyl transferase (GGT) (80%). Eight operative reports noted that the cystic duct was noticeably dilated at the time of cholecystectomy. Two patients developed a cystic duct leak (Strasberg type A bile duct injury) postoperatively, which was managed nonoperatively. Six cases of RCDL required surgery, and six were managed endoscopically.
  
  
  CONCLUSIONS
  RCDL is a potential cause of postcholecystectomy syndrome, but the true incidence is unknown. Laboratory analysis and imaging are helpful in establishing the diagnosis of RCDL. Endoscopic therapy has a role in the treatment of RCDL, but surgical excision of the remnant cystic duct lithiasis may be required.
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA, miphilli@unch.unc.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
authors.forename: Mark
authors.initials: M
authors.lastname: Joseph
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.forename: Ian
authors.initials: I
authors.lastname: Grimm
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Rupp
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D003549:Cystic Duct / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult