REMOVAL OF A CYSTIC DUCT STONE DURING LAP AROSCOPIC CHOLECYSTECTOMY

Occluding stones left in the stumpf of the cystic duct may account for between 17% and 25% of the cases of post-cholecystectomy sydrome. Whe n acutely inflamed or empyemic gallbladders are removed, an occlusive cystic duct stone must almost always be expected. When performing lapa roscopic cholecystectomy, therefore, care must be taken to ensure that any stone occluding the cystic duct are detected and removed. After c ompletely freeing the cystic duct to the point of its junction with th e common bile duct, it is carefully ''palpated'' with a 5 mm forceps f or the presence of stones. Any such present are pressed out of the duc t through a transverse incision, and retrieved. Bile reflux through th e incision in the duct indicates freedom from stones. Finally, intraop erative cholangiography can be performed.