i have patient 50-year-old post lap cholecystectomy2month complain from RUQ pain the ,cystic duct more than, 2/3 left in place and its tortuous and contain small 5-6mm stone so what is the best intervention for management of retained cystic duct stone with out merrizi after lap cholecystectomy ?
please ref my paper on RG about lap stump cholecystectomy,probably ours is one of the large series.
Agreed with Prasanna Kumar Reddy --- Laparoscopic completion cholecystectomy: A retrospective study of 40 cases by Amit Kumar Parmar et al. Asian Journal of Endoscopic Surgery. Volume 6, Issue 2, pages 96–99, May 2013
Laparoscopic approach in experienced hands could be the option, although some literatures may recommend ERCP.
I would perform ERCP first with sfintherotomy using balloon extractor not basket
I have had similar cases referred to our unit and have undergone completion cholecystectomy with satisfactory outcomes.I believe you should go back again and do a completion cholecystectomy, if expertise available otherwise refer to expert. Redo lap cholecystectomy would be difficult and requires higher degree of skill otherwise would land up with biliary complications.
The best is SpyGlas cholangiopscopy with Lazer therapy to fragment it but be careful to injury the duct as well as carefully from the pressure of the cholangioscope on the CBD junction with duodenum at 6 Oclock position
with my best regards
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