Cystic duct remnants and biliary symptoms after cholecystectomy. A randomised comparison of two operative techniques.

To assess the importance of cystic duct remnants in causing biliary symptoms after cholecystectomy 80 patients undergoing routine cholecystectomy were randomised to have conventional cholecystectomy (n = 40) or cholecystectomy with removal of the whole cystic duct (n = 40). Fifteen were withdrawn, leaving 65 (32 who had standard cholecystectomy and 33 who had cholecystectomy by the new technique) for analysis. Thirty of the 32, and 27 of the 33, were available for follow up one, two, three, and eight years after operation; 11 of the 30 (37%) compared with 23 of the 27 (85%) were free of biliary symptoms during the eight year period (p less than 0.001). We conclude that removal of the stump of the cystic duct improves the success rate of cholecystectomy in the treatment of gallstones.