Laparoscopic subtotal cholecystectomy without cystic duct
Our findings are consistent with other studies that reported only 2% of the cases where the RPSBD drained into the cystic duct
. Prior information on HCS will help in dealing with the anatomical abnormality especially in the context of RPSBD, where the cystic duct
can be ligated between the gallbladder and the point at which the duct joins [27,28].
The cystic duct
was identified, and a stone was found to be lodged in the cystic duct
, which was then manipulated up into the fundus.
The reasons for conversion included cystic artery bleeding2, liver bed bleeding1, common hepatic duct injury1, cholecystoduodenal fistula1, severe adhesions caused by tissue inflammation and fibrosis of Calot's triangle1 and cystic duct
ACC represents over 90% of all AC cases, (1) initiated by a sentinel event of an obstructing gallstone in the gallbladder neck or cystic duct
. The pathophysiology of AAC is multifactorial and not completely understood, except that an obstructing gallstone is absent.
LSC Type I: Cystic Duct
and Cystic Artery are dissected and clipped and cut.
LC was conducted using slightly anti-Trendelenburg and left tilting position; cystic artery was first dissected and divided after clipping; the gallbladder was dissected off the liver with only cystic duct
kept intact; then a clip was applied on cystic duct
close to Hartmann's pouch.
The cystic duct
may join the left or the right side of the common hepatic duct or may join the left hepatic duct directly.
Therefore laparoscopic cholecystectomy may be responsible for specific complications which occur as a result of inadvertent division of common bile duct or hepatic duct identified as cystic duct
, inappropriate clipping of CBD or hepatic duct, or liberal use of diathermy involving biliary tree, vessels and bowel.3
In a retrospective analysis of 100 patients with post-cholecystectomy bile leak, ERCP demonstrated a leak in 83% with 60% of them being from cystic duct
stump.11 ERCP stenting with sphincterotomy reduces the transpapillary pressure gradient maintained by sphincter of Oddi, thus diverting the bile away from leak into the duodenum as well as removing underlying biliary obstruction which may perpetrate or worsen the ductal defect.
In 95% of cases of acute cholecystitis the cause is a gallstone blocking the cystic duct
subsequently leading to inflammation of the gallbladder by chemicals or bacteria (1).
Perihilar tumors are defined as those involving the hepatic duct bifurcation or extrahepatic biliary tree proximal to the origin of the cystic duct
(1); distal tumors are defined as those lesions arising between the junction of the cystic duct-bile duct and the ampulla of Vater.