Essa M Aleassa, MD, MSc, Kevin M El-Hayek, MD. Section of Hepatopancreatobiliary Surgery, General Surgery, Cleveland Clinic Foundation
Introduction: Presentation of recurrent symptoms of calculous biliary disease after remote cholecystectomy should hint at the presence of a retained cystic duct remnant stone. While non-surgical options should be attempted first, they can be unsuccessful. This video demonstrates a safe approach to laparoscopic cystic duct remnant resection with a focus on intraoperative adjuncts.
Patient and Methods: The patient is a 63 year-old male who underwent a remote laparoscopic converted to open cholecystecomy for acute calculous cholecystitis. Several decades later, the patient presented with abdominal pain and was diagnosed with cholangitis and pancreatitis. He was noted to have a cystic duct remnant stone. Endoscopic retrograde cholangiopancreatography failed to clear the cystic duct; therefore, the patient was referred for surgical evaluation.
Results: The patient underwent laparoscopic lysis of adhesions aided by intraoperative laparoscopic ultrasound and cholangiogram to help clarify the biliary anatomy. Identification of the anatomy allowed for laparoscopic resection of the cystic duct with complete clearance of biliary stones. The operation was 202 minutes with minimal blood loss (25ml). The patient recovered well and was discharged on post-operative day-1 without drains. No perioperative complications were noted.
Conclusion: Cystic duct remnant resection is a complex procedure due to distorted anatomy. It is further complicated by its close proximity to the portal triad. Careful dissection is challenging in such settings but can be aided by intraoperative technology such as laparoscopic ultrasound and cholangiogram. To our knowledge, this is the first description of complete laparoscopic cystic duct remnant resection by combining multiple intraoperative adjuncts.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94355
Program Number: V029
Presentation Session: HPB Videos
Presentation Type: Video