Surgical strategy modification upon intraoperative finding of cystic duct stones

Abstract

Background: laparoscopic cholecystectomy is the Gold Standard treatment for gallstone disease. To prevent bile duct injuries, most surgeons begin cystic duct dissection near the gallbladder. This usually leaves a long cystic duct stump. The incidence of cystic duct stones is 12.3-19% in Western series and 14.7% in Japan.
Objective: the aim of this study is to analyse cysctic duct stone prevalence and its relation with cho- ledocolithiasis.
Materials and methods: prospective non-randomized study, between January 2013 and December 2014.
Results: 387of 435 laparoscopic cholecystectomies were included for analysis. 62 cases (16%) had cystic duct stones, being significantly more frequent in non-complicated gallbladder disease and extrahepatic cholestasis. The presence of cystic duct stones correlated significantly with choledocolithiasis in non-complicated gallbladder disease and cholecystitis. Transcystic instrumentation was successful in 96% of these cases.
Conclusion: the finding of cystic duct stones during laparoscopic cholecystectomy could lead to a more difficult surgery mostly because the incidence of choledocolithiasis is higher. Transcystic instrumentation success rate is 96% in our series.