THE PROBLEMS WITH CYTIC DUCT CALCULI : A RETROSPECTIVE ANALYSIS
Introduction: Calculi within the Cystic Duct are usually reported less on USS Abdomen preoperatively due to its low incidence and difficult imaging. They are often detected during Cholecystectomy, more often laparoscopically in a magnified image. Large calculi within the Cystic Duct do pose operative difficulties in identifying the structures within the Calot’s triangle especially if biliary/ cystic duct variants are present. Intra operatively, aberrant pathology has a propensity for injury of the Cystic artery and the CBD. If left behind during the operation, the retained Cystic Duct calculi do become symptomatic over a period of time. Patients with symptomatic remnant cystic duct calculi are re-operated which has a direct impact on the quality of life.
Materials and Methods: 2250 of Gall Stone Diseases cases were taken up for laparoscopic cholecystectomy. Open cholecystectomy was performed in 80 cases (3.55%). Subtotal cholecystectomy was done in 30 (1.38%) and 8 (10%) cases respectively in laparoscopic and open procedures respectively. 7 patients were referred from different hospitals post operatively who reported with symptoms of post cholecystectomy syndrome, biliary pain and cholangitis and were re operated.
Results: Preoperative diagnosis of cystic duct calculi with USS and MRCP was made in 76 cases (3.37%). In addition, 35 new cases were diagnosed to have cystic duct calculi intra operatively making it a total of 111 cases (4.933%).
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