Manoj K Choudhury, MS, FMAS, Hrishikesh Deka, MS. Nemcare Superspeciality Hospital
Objective: Re-laparoscopy in gall bladder or cystic duct remnant with calculous disease is a technically difficult approach. It carries increased conversion and biliary complications. But the morbidity is significantly reduced if performed successfully. Our objective is to reduce the morbidity of the patient.
Method & procedure: A lady aged 37 years was presented with recurrent acute upper abdominal pain radiating to the back since last two months. She had undergone laparoscopic cholecystectomy in 2010. Ultrasound examination showed cystic duct calculi. MRCP report showed multiple calculi in GB Stump with intra hepatic biliary dilatation. CBD diameter showed 10 mm. After complete work up and satisfactory counseling she was prepared for re-laparoscopy.
Under general anesthesia CO2 insufflations was done and ports were introduced as done in conventional laparoscopic cholecystectomy. Adhesiolysis was done and porta was exposed. Cystic duct Stump with the calculi was found to be buried alongside the CHD and was carefully dissected out. Stump showed low insertion into the postero- lateral wall of CBD. A calculus was found impacted at cystic duct-CBD junction. Calculus was niched out and the remnant cystic duct stump was excised. The stump was transfixed. Normal saline irrigation was given, drainage applied and ports were closed.
Results: Post operative period was uneventful. Drainage was removed next day and the patient was discharged with advice.
Conclusion: Re-laparoscopy in cystic duct remnant is a technically difficult procedure. Advances in technology and technical skill are necessary to perform safe surgery
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95851
Program Number: V187
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop