Completion Cholecystectomy for Symptomatic Cystic Duct Stump Calculi

Cystic duct stump remnant causing "postcholecystectomy syndrome" is an uncommon but clinically significant complication. Symptomatic cystic duct stump stones often necessitate redo completion cholecystectomy. Here, we share our experience with the clinical presentation and surgical management of this condition.

This prospective study included 60 patients with residual cystic duct disease who underwent completion cholecystectomy between August 2016 and September 2024. Investigations included abdominal ultrasound and magnetic resonance cholangiopancreatography. The demographic, clinical, surgical and early post-operative variables of these patients were prospectively maintained and analyzed.

The study included 43 women and 17 men with symptomatic cystic duct remnant. The median age was 43.5 years (range, 14-80 years). The median duration between index surgery and completion cholecystectomy was 66 months (range, 2-384 months) (interquartile range, 105 months). The initial surgery was open cholecystectomy in 44 and laparoscopic cholecystectomy in 16 patients. Fifty-six (93.3%) patients with residual stump stone presented with pain, while 24 (40%) patients complained of dyspepsia. Completion cholecystectomy could be performed laparoscopically in 47 cases, whereas 10 patients underwent open surgery. The mean operative time was 85 minutes (standard deviation = 32.1, confidence interval = 95%). The mean hospital stay was 3 days (interquartile range [IQR], 1-4.5 days). Iatrogenic bile duct injury occurred in 2 (3.3%) cases out of which one was repaired laparoscopically and the other required conversion to open and repair over T tube.

Laparoscopic completion cholecystectomy is feasible and safe, even in patients with prior open cholecystectomy. It is becoming the treatment of choice where expertise is available.