Surgical and endoscopic management of remnant cystic duct lithiasis after cholecystectomy--a case series

J Gastrointest Surg. 2014 Jul;18(7):1278-83. doi: 10.1007/s11605-014-2530-4. Epub 2014 May 9.


Introduction: Postcholecystectomy syndrome (PCS) as a result of remnant cystic duct lithiasis (RCDL), or gallstones within the cystic duct after cholecystectomy, can cause persistent or recurrent symptoms after cholecystectomy.

Study design: A retrospective descriptive analysis was performed for all patients with RDCL at a single institution between 2001 and 2012. Details of presentation, diagnosis, and surgical and endoscopic treatments, and outcomes were collected and analyzed.

Results: Twelve patients with RCDL were identified. The interval between cholecystectomy to RCDL discovery was 34.2 months (range 0.5-168 months). On a standard liver enzyme panel, 75% of patients had derangements in ≥1 indices, with the most common single laboratory test abnormality occurring in gamma-glutamyl transferase (GGT) (80%). Eight operative reports noted that the cystic duct was noticeably dilated at the time of cholecystectomy. Two patients developed a cystic duct leak (Strasberg type A bile duct injury) postoperatively, which was managed nonoperatively. Six cases of RCDL required surgery, and six were managed endoscopically.

Conclusion: RCDL is a potential cause of postcholecystectomy syndrome, but the true incidence is unknown. Laboratory analysis and imaging are helpful in establishing the diagnosis of RCDL. Endoscopic therapy has a role in the treatment of RCDL, but surgical excision of the remnant cystic duct lithiasis may be required.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Cholecystectomy / adverse effects
  • Cholecystectomy / methods*
  • Cholecystectomy, Laparoscopic / adverse effects
  • Cholecystectomy, Laparoscopic / methods
  • Cholecystolithiasis / diagnostic imaging
  • Cholecystolithiasis / surgery*
  • Choledocholithiasis / diagnostic imaging
  • Choledocholithiasis / surgery*
  • Cohort Studies
  • Cystic Duct / diagnostic imaging
  • Cystic Duct / physiopathology
  • Cystic Duct / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Postcholecystectomy Syndrome / diagnostic imaging
  • Postcholecystectomy Syndrome / surgery*
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / surgery
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome
  • Young Adult