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Laparoscopic cystic duct exploration

Objective To evaluate the benefits of routine cystic duct exploration during laparoscopic cholecystectomy (LC). Background The era of LC has been established as it decreases postoperative pain, shortens the hospital stay, and returns the patient to full activity within 1 week. Cystic duct stones (CDS) especially in patients with multiple tiny gallbladder are implicated in postcholecystectomy pain, failure of insertion of transcystic intraoperative cholangiography catheter, and the subsequent development of common bile duct (CBD) stones. Patients and methods This was a prospective study that included 30 patients with chronic calcular cholecystitis with multiple tiny stones. The patients were operated at the Department of General Surgery, Menoufia University Hospital between December 2015 and August 2016. All patients were scheduled for LC with exploration of cystic duct; intraoperative cholangiogram was done only for five cases. Results CDS were detected in nine cases in different patterns (multiple stones, single stone, gravels). CDS were detected more in patients with elevated liver functions including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transferase. CDS were detected more in patients with dilated cystic duct. CBD stones were found in one case detected by transcystic intraoperative cholangiography; endoscopic retrograde cholangiopancreaticography was done in the same session. No postoperative complications were found regarding bile leak, obstructive jaundice, and postcholecystectomy pain. Conclusion Cystic duct exploration as a routine step in LC especially in patients with multiple gallbladder stones is a safe and easy to perform procedure that may help in protection against complications after cholecystectomy including postcholecystectomy pain, missed CBD stones, and pancreatitis with no increase in the time of procedure or risk on patients.