Journal of Gastrointestinal Surgery

, Volume 18, Issue 7, pp 1278–1283 | Cite as

Surgical and Endoscopic Management of Remnant Cystic Duct Lithiasis After Cholecystectomy—a Case Series

  • Michael R. PhillipsEmail author
  • Mark Joseph
  • Evan S. Dellon
  • Ian Grimm
  • Timothy M. Farrell
  • Christopher C. Rupp
Original Article



Postcholecystectomy syndrome (PCS) as a result of remnant cystic duct lithiasis (RCDL), or gallstones within the cystic duct after cholecystectomy, can cause persistent or recurrent symptoms after cholecystectomy.

Study Design

A retrospective descriptive analysis was performed for all patients with RDCL at a single institution between 2001 and 2012. Details of presentation, diagnosis, and surgical and endoscopic treatments, and outcomes were collected and analyzed.


Twelve patients with RCDL were identified. The interval between cholecystectomy to RCDL discovery was 34.2 months (range 0.5–168 months). On a standard liver enzyme panel, 75 % of patients had derangements in ≥1 indices, with the most common single laboratory test abnormality occurring in gamma-glutamyl transferase (GGT) (80 %). Eight operative reports noted that the cystic duct was noticeably dilated at the time of cholecystectomy. Two patients developed a cystic duct leak (Strasberg type A bile duct injury) postoperatively, which was managed nonoperatively. Six cases of RCDL required surgery, and six were managed endoscopically.


RCDL is a potential cause of postcholecystectomy syndrome, but the true incidence is unknown. Laboratory analysis and imaging are helpful in establishing the diagnosis of RCDL. Endoscopic therapy has a role in the treatment of RCDL, but surgical excision of the remnant cystic duct lithiasis may be required.


Remnant cystic duct lithiasis (RCDL) Cholecystectomy Postcholecystectomy syndrome 



Remnant cystic duct lithiasis


Gamma-glutamyl transferase


Postcholecystectomy syndrome


Aspartate aminotransferase


Alanine aminotransferase


Conflict of Interest

All authors declare that they have no conflicts of interest. This paper has not been published previously.


Institutional support was provided by the Department of Surgery at the University of North Carolina at Chapel Hill. There are no relevant financial disclosures.


  1. 1.
    Russo MW, Wei JT, Thiny MT, Gangarosa LM, et al. Digestive and liver diseases statistics, 2004. Gastroenterology 2004;126:1448-53.PubMedCrossRefGoogle Scholar
  2. 2.
    Zhou PH, Liu FL, Yao LQ, Qin XY. Endoscopic diagnosis and treatment of post-cholecystectomy syndrome. Hepatobiliary Pancreat Dis Int 2003;2:117-20.PubMedGoogle Scholar
  3. 3.
    Mergener K, Clavien PA, Branch MS, Baillie J. A stone in a grossly dilated cystic duct stump: a rare cause of postcholecystectomy pain. Am J Gastroenterol 1999;94:229-31.PubMedCrossRefGoogle Scholar
  4. 4.
    Goenka MK, Kochhar R, Nagi B, Bhasin DK, et al. Endoscopic retrograde cholangiopancreatography in postcholecystectomy syndrome. J Assoc Physicians India 1996;44:119-22.PubMedGoogle Scholar
  5. 5.
    Rogy MA, Fugger R, Herbst F, Schulz F. Reoperation after cholecystectomy. The role of the cystic duct stump. HPB Surg 1991;4:129-34; discussion 34-5.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Stefanini P, Carboni M, Patrassi N, Loriga P, et al. Factors influencing the long term results of cholecystectomy. Surg Gynecol Obstet 1974;139:734-8.PubMedGoogle Scholar
  7. 7.
    Gui GP, Cheruvu CV, West N, Sivaniah K, et al. Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up. Ann R Coll Surg Engl 1998;80:25-32.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Walsh RM, Ponsky JL, Dumot J. Retained gallbladder/cystic duct remnant calculi as a cause of postcholecystectomy pain. Surg Endosc 2002;16:981-4.PubMedCrossRefGoogle Scholar
  9. 9.
    Palanivelu C, Rangarajan M, Jategaonkar PA, Madankumar MV, et al. Laparoscopic management of remnant cystic duct calculi: a retrospective study. Ann R Coll Surg Engl 2009;91:25-9.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Pernice LM, Andreoli F. Laparoscopic treatment of stone recurrence in a gallbladder remnant: report of an additional case and literature review. J Gastrointest Surg 2009;13:2084-91.PubMedCrossRefGoogle Scholar
  11. 11.
    Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101-25.PubMedGoogle Scholar
  12. 12.
    Rozsos I, Magyarodi Z, Orban P. [Cystic duct syndrome and minimally invasive surgery]. Orv Hetil 1997;138:2397-401.PubMedGoogle Scholar
  13. 13.
    Sitenko VM, Nechai AI, Stukalov VV, Kalashnikov SA. [Large stump of the cystic duct]. Vestn Khir Im I I Grek 1976;116:56-9.PubMedGoogle Scholar
  14. 14.
    Freud M, Djaldetti M, De Vries A, Leffkowitz M. Postcholecystectomy syndrome: a survey of 114 patients after biliary tract surgery. Gastroenterologia 1960;93:288-93.PubMedCrossRefGoogle Scholar
  15. 15.
    Sezeur A, Akel K. Cystic duct remnant calculi after cholecystectomy. J Visc Surg 2011;148:e287-90.PubMedCrossRefGoogle Scholar
  16. 16.
    Glenn F, McSherry CK. Secondary abdominal operations for symptoms following biliary tract surgery. Surg Gynecol Obstet 1965;121:979-88.PubMedGoogle Scholar
  17. 17.
    Chowbey PK, Bandyopadhyay SK, Sharma A, Khullar R, et al. Laparoscopic reintervention for residual gallstone disease. Surg Laparosc Endosc Percutan Tech 2003;13:31-5.PubMedCrossRefGoogle Scholar
  18. 18.
    Benninger J, Rabenstein T, Farnbacher M, Keppler J, et al. Extracorporeal shockwave lithotripsy of gallstones in cystic duct remnants and Mirizzi syndrome. Gastrointest Endosc 2004;60:454-9.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Michael R. Phillips
    • 1
    Email author
  • Mark Joseph
    • 1
  • Evan S. Dellon
    • 2
  • Ian Grimm
    • 2
  • Timothy M. Farrell
    • 1
  • Christopher C. Rupp
    • 3
  1. 1.Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of SurgeryPrevea HealthGreen BayUSA

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