[Cystic duct syndrome and minimally invasive surgery]

Cholecystectomy is an established successful operation which provides total relief of presurgical symptoms in up to 85% of patients. About 5% of patients after cholecystectomy experience severe episodes of upper abdominal pain, similar to those that they had prior to cholecystectomy. These so called postcholecystectomy syndromes may be due to biliary strictures, retained biliary calculi, cystic duct stump syndrome, stenosis or dyskinesis of the sphincter of Oddi. Postcholecystectomy symptoms caused by cystic stump and gallbladder remnant had been described early in this century and several papers have been published on the topic. During recent years laparoscopic cholecystectomy became popular but we have not found in the literature the mention of either that it could cause cystic duct stump syndrome or it could be used for its treatment. During the last seven years in 8 patients we found gallbladder remnants or cystic duct stumps causing their symptoms. Among the 8 patients 3 had laparoscopic and 5 classic cholecystectomies. After incomplete cholecystectomy we usually find that the cystic duct stump and the Calot triangle embedded in inflamed scar tissue. For this reason the surgical risk is to high with laparoscopic surgery to reoperate for these pathological changes. In all 8 cases the pathological cystic duct stumps and gallbladder remnants were removed using 3-4 cm single microlaparotomy incisions. The postoperative stay of these patients were uneventful and they were discharged home 2-3 days after surgery.