Diagnosis and treatment of cystic duct stump failure after cholecystectomy

Objective. To identify the causes of cystic duct stump failure after cholecystectomy and diagnostic effectiveness of magnetic resonance cholangiography. Material and methods. We retrospectively analyzed examination and treatment of 30 patients with cystic duct stump failure after cholecystectomy. Patients underwent ultrasound (30), CT (17), MR-cholangiography (25), transfistular cholangiography (3). Minimally invasive (83.33%) and open surgical interventions (16.67%) were used. The Statistica 10 program was used for statistical analysis. Results. The causes of bile leakage from cystic duct stump were ligation defects in 60% and biliary hypertension in 40% of cases. MR-cholangiography allowed to exclude intersection of bile ducts in 24 out of 25 cases and to diagnose biliary hypertension in 10 cases. Specificity and negative prognostic value of MR-cholangiography for diagnosis of intersection of extrahepatic bile ducts was 96%. Patients with external biliary fistula (24) underwent endoscopic papillotomy and bile duct stenting with a stent above cystic stump (with removal of bile stones in 7 cases). A nitinol stent was installed in one case. Five (16.67%) patients underwent additional relaparoscopy for abdominal effusion. In all cases, bile leakage stopped within 1–5 (1 [0; 3]) days. Laparotomy, choledocholithotomy (1), transduodenal papillotomy (1), and external drainage of bile ducts (5) were performed for signs of peritonitis. Conclusion. Endoscopic papillotomy combined with bile duct stenting with or without lithoextraction makes it possible to early eliminate bile leakage in case of cystic duct stump failure with bile leakage.