Background: Laparoscopic cholecystectomy revolutionized the management of Gall stone disease, which is now designated as the gold standard treatment for symptomatic cholelithiasis. However, around 15-20% of patients continue to have post-cholecystectomy syndromes, the causes of which are diverse. One crucial reason is retained cystic duct stones, which are usually missed intraoperatively. Focused attention towards the same with some intraoperative manoeuvres would help to reduce their contribution to the post-cholecystectomy syndrome. Methods: The study was carried over two years, from June 2019-March to 2021, during which 380 Laparoscopic Cholecystectomy were studied. Patients detected to have cystic duct stones by noting abnormal bulge, adhesions, nonuniformity of duct and confirmed by tactile sensation by instrument. These patients were subjected to different intraoperative manoeuvres like milking of duct, complete dissection of CD-CBD junction and ligation of CD close to CBD, the opening of cystic duct over stone etc., were utilized. Results: We found cystic duct stones in 40(10.5%) out of 380 Laparoscopic cholecystectomies performed, which were managed laparoscopically. We have made some classifications according to the position of stone in the cystic duct and managed accordingly. Upon follow-up, we found that out of 40 patients with detected cystic duct stones; no patients had any complaints postoperatively until now. Conclusion: We conclude that the incidence of CD stones is underestimated and under-reported, which is a significant cause of PCS. However, suppose attention is given to CD during Laparoscopic cholecystectomy and adapting some simple and safe manoeuvres. In that case, they can be effectively managed, which can decrease the possibility of the postcholecystectomy syndrome, Remnant cystic duct stump stone, and post-op CBD stone.
Key words: Laparoscopic cholecystectomy, Post-cholecystectomy syndromes, Cystic duct calculi, Common bile duct, Cystic duct
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