Post-Cholecystectomy Gall Bladder Remnant and Cystic Duct Stump Stone
关键词
抽象
描述
The incidence of gall bladder and cystic duct stump stones has been reported to be 5% of patients after urgent cholecystectomy, and it is rare after elective operations . The incidence of incomplete gallbladder removal following laparoscopic cholecystectomy is 13.3% . Partial cholecystectomy may be resorted to in many conditions such as difficult dissection in Calot's triangle that can be hazardous to common bile duct and/or blood vessels. In such cases, many surgeons leave a part of the gall bladder in the manner described by author after removing all stones from the remaining cuff of the gallbladder To prevent the incidence of gallbladder remnant/cystic duct stump calculi, the cystic duct should be fully skeletonized till 1 cm from the common bile duct. Stones in the cystic duct should be milked back to the gallbladder before clipping Routine use of intraoperative cholangiography is not a must but when used it can be useful in detecting calculi in the cystic duct The diagnosis of cystic duct stump syndrome is always into the dilemma of post cholecystectomy syndromes and leads to delayed diagnosis. Cystic duct stump syndrome may be misdiagnosed with reflux esophagitis, peptic ulceration, irritable bowel syndrome or chronic pancreatitis hepatitis, mesenteric ischemia, diverticulitis, and organic or motor intestinal disorders.
The imaging approach to post cholecystectomy syndrome includes ultrasonography, computed tomography (CT) scan, endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP).
The purpose of this study is to emphasis that laparoscopic completion cholecystectomy is the best surgical option for cystic duct stump and gall bladder remnant syndrome as regard safety to the patients...
There may be gender specific risk factor for developing post-cholecystectomy syndrome, in present study; the incidence was 70% in females (14 cases) compared to 30% in males (6 cases). This higher incidence in females was also reported , whom stated that the male to female ratio was 1:1.45.
The symptoms of gall bladder syndrome may be nil or they can present with acute symptoms (biliary colic, acute cholecystitis or acute pancreatitis) or chronic symptoms (persistent right upper quadrant discomfort or pain, food intolerance, nausea or jaundice). The persistence of symptoms after cholecystectomy points to the possibility of a gallbladder remnant, especially when coupled with radiation of pain to the shoulder, food intolerance, nausea or jaundice . abdominal pain and persistent dyspepsia as the commonest presentation were stated by other study , while , reported that patients was referred to their institution without persistent symptoms after cholecystectomy .In the present study, most cases presented with right hypochondrial pain (18 cases) and asymptomatic cases are 2 cases and discovered accidently by ultrasonography for other unrelated symptoms.
日期
最后验证: | 02/29/2020 |
首次提交: | 03/29/2020 |
提交的预估入学人数: | 03/29/2020 |
首次发布: | 03/31/2020 |
上次提交的更新: | 03/30/2020 |
最近更新发布: | 04/02/2020 |
实际学习开始日期: | 12/31/2012 |
预计主要完成日期: | 12/31/2017 |
预计完成日期: | 12/31/2019 |
状况或疾病
干预/治疗
Procedure: open completion cholecystectomy
Procedure: laparoscopic completion cholecystectomy
相
手臂组
臂 | 干预/治疗 |
---|---|
Active Comparator: open completion cholecystectomy open completion cholecystectomy for cystic duct stump stone | Procedure: open completion cholecystectomy open excision of cystic duct remnant |
Active Comparator: laparoscopic completion cholecystectomy lap completion cholecystectomy for cystic duct stump stone | Procedure: laparoscopic completion cholecystectomy lap excision of cystic duct stone |
资格标准
有资格学习的年龄 | 30 Years 至 30 Years |
有资格学习的性别 | All |
接受健康志愿者 | 是 |
标准 | Inclusion Criteria: - • Age: 30-50 - Both sex - Previous cholecystectomy(open or laparoscopic) - With or without common bile duct stone. - Symptomatic or Exclusion Criteria: - • 1-patients unfit for surgery - 2-patient refused surgery. |
结果
主要结果指标
1. postoperative pain severity on visual analogue score [2 weeks]
次要成果指标
1. intraoperative time in minutes [2 hours]