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Abhilash Jayachandran 10.5005/jp-journals-10033-1267
REVIEW ARTICLE

Stump Cholecystitis

Abhilash Jayachandran

ABSTRACT pressure have all served as causes of postcholecystectomy
1
Laparoscopic cholecystectomy is most commonly performed problems . The entire sphincteric system of the distal bile
minimal access surgery by general surgeons. But still, some post- duct and the pancreatic duct is commonly referred to as
operative patients are not getting relieved from their symptoms. the sphincter of Oddi.
Most retrospective studies show that presence of stone is mostly
in the cystic duct or in the common bile duct and some also show Follow-up
the presence of cystic stump (1–1.5 cm). Most of the patients
with complaints were thoroughly evaluated and subjected to Maximum patients followed-up while some have not even
completion cholecystectomy. These patients were followed-up turned back. But followed-up patients were doing well.
from 6 months to 1 year and all patients were asymptomatic.
Keywords: Common bile duct stone, Gallbladder stone MATERIALS AND METHODS
disease, Laparoscopic cholecystectomy, Remnant gallbladder,
Stump cholecystitis. Data were collected retrospectively from 1991 to 2014
regarding postcholecystectomy syndrome in patients and
How to cite this article: Jayachandran A. Stump Cholecystitis.
World J Lap Surg 2016;9(1):34-37. after completion cholecystectomy they were relieved of
symptoms. Out of these patients some were referred with
Source of support: Journal of Minimal Access Surgery,
PUBMED, HINDAWI, Asian Journal of Endoscopic surgeon, common bile duct (CBD) calculus with gallbladder stump
Hepato-Pancreato- Biliary HPB) Surgery Cystic. and some with cystic duct calculi as per their ultrasound
reports (Table 1). There were also patients who suffered
Conflict of interest: Remanant stones in CBD may lead to
stump cholecystitis due to stump cholecystitis because of inadequate removal
of gallbladder. Revision cholecystectomy was performed
INTRODUCTION in all patients with symptoms even after cholecystectomy.
In laparoscopic cholecystectomy, the optical port was
Erich Muhe performed the first laparoscopic chole- introduced in the umbilical area, whereas in postoperative
cystectomy in 1982; he used a modified operating history first port was introduced through the palmer’s
laparoscope and placed it at the umbilicus after establishing point to rule out adhesions. Nowadays, the port placement
pneumoperitoneum. Laparoscopic cholecystectomy is on the basis of baseball diamond technique.
becomes the gold standard treatment for cholelithiasis
in that era. In 1987, Philippe Mouret performed first Port Positioning
video laparoscopic cholecystectomy by attaching a • Camera port of size 10 mm was introduced in the
camera to his laparoscope. Various causes are described umbilicus (Fig. 1).
for the postoperative symptoms and together they are • A 5 mm port was inserted below the costal margin in
kept under one group known as postcholecystectomy midclavicular line.
syndrome. The remnants of the cystic duct or gallbladder • Liver refractor of 5 mm was placed in mid to the
in subtotal cholecystectomy has historically been anterior axillary line at the level of the umbilicus.
implicated as the source of pain, nausea and vomiting in
postcholecystectomy patients. An increase in choledochal RESULTS
pressure results in cystic stump distension, inflammation.
Stone obstruction within remnants of the cystic duct or Among these patients, some patients had a direct
gallbladder and an increase in the sphincter of Oddi radiological finding of calculi in the common bile
duct and some were having both calculi in CBD and
stump cholecystitis. All patients were not benefited
Assistant Professor with endoscopic retrograde cholangiogram, as the size
Department of General Surgery, Vinayaka Mission Medical of the calculi were large and proceeded with surgery.
College, Karaikal, Puducherry, India In some patients along with laparoscopic completion
Corresponding Author: Abhilash Jayachandran, Assistant cholecystectomy, CBD exploration was also done. Those
Professor, Department of General Surgery, Vinayaka patients who underwent CBD exploration, intraoperative
Mission Medical College, Karaikal, Puducherry, India, Phone: choledochoscopy was also performed and CBD closure
+919489838717, e-mail: moscow2020@gmail.com
was done after placing a stent.
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