Kumar Saket, Langhe Makarand, Kumar Abhay, Sharma Ashish Kumar, Shanker Abhay, Mandal Manish
Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. (Drs. S. Kumar, Langhe, Sharma, Shanker and Mandal).
Department of General Surgery, BIG Apollo Spectra Hospitals, Agamkuan, Patna, Bihar, India. (Dr. A. Kumar).
JSLS. 2025 Apr-Jun;29(2). doi: 10.4293/JSLS.2025.00034. Epub 2025 Jun 20.
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.
胆囊管残端残留导致“胆囊切除术后综合征”是一种罕见但具有临床意义的并发症。有症状的胆囊管残端结石通常需要再次行胆囊切除术。在此，我们分享我们对这种情况的临床表现和手术治疗的经验。
这项前瞻性研究纳入了2016年8月至2024年9月期间接受再次胆囊切除术的60例胆囊管残留疾病患者。检查包括腹部超声和磁共振胰胆管造影。对这些患者的人口统计学、临床、手术及术后早期变量进行前瞻性记录和分析。
该研究包括43名女性和17名男性有症状的胆囊管残留患者。中位年龄为43.5岁（范围14 - 80岁）。初次手术至再次胆囊切除术的中位时间为66个月（范围2 - 384个月）（四分位间距为105个月）。初次手术44例行开腹胆囊切除术，16例行腹腔镜胆囊切除术。56例（93.3%）残留残端结石患者出现疼痛，24例（40%）患者主诉消化不良。47例可通过腹腔镜行再次胆囊切除术，10例患者接受了开放手术。平均手术时间为85分钟（标准差 = 32.1，置信区间 = 95%）。平均住院时间为3天（四分位间距[IQR]，1 - 4.5天）。2例（3.3%）发生医源性胆管损伤，其中1例通过腹腔镜修复，另1例需要转为开腹并经T管修复。
即使是既往接受过开腹胆囊切除术的患者，腹腔镜再次胆囊切除术也是可行且安全的。在有专业技术的地方，它正成为首选的治疗方法。
