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PubMed1983

Cholecystokinin constricts the canine cystic duct.

The effects of cholecystokinin and cholecystokinin-octapeptide on the canine cystic duct have been studied. The resistance to flow through the duct in vivo, assessed by measuring the flow rate of saline that was perfused through the duct at constant pressure, was increased by cholecystokinin in a dose-dependent manner. Cholecystokinin also produced the well-recognized, dose-dependent elevations of gallbladder intraluminal pressure. Comparison of dose-response curves prepared in each animal indicated that the sensitivity of the cystic duct was significantly lower than that of the gallbladder. Isolated strips of cystic duct and gallbladder in vitro were contracted by cholecystokinin or cholecystokinin-octapeptide; again, cystic duct muscle displayed a lower sensitivity than gallbladder to the contractile effects of these agents. It is not known whether cholecystokinin can affect cystic duct resistance under physiologic conditions.

Animals↗
PubMed1996

[Three-dimensional images of the cystic duct obtained with helical DIC CT].

Before laparoscopic cholecystectomy, it is important to clarify the anatomy of the cystic duct. This study assessed three-dimensional CT images (3D images) of the cystic duct obtained non-invasively using helical DIC CT and these images were compared with those obtained with ERCP and DIC. The three-dimensional technique using Helical DIC-CT was applied in 168 patients for laparoscopic cholecystectomy. The cystic duct detected by 3D imaging was evaluated for patency, length and bifurcation. Three-dimensional images showed the cystic duct in 157 of 168 cases (93.5%) and in 81 of 89 cases (91%) in which the cystic duct was not clearly visualized on DIC. Among the 23 cases in which were both 3D images and ERCP undergone, 3D images were equal to those of ERCP in detection of the cystic duct in 20 cases, superior to ERCP in two cases, and inferior to ERCP in one. The technique of 3D images proved useful in demonstrating the patency, length and variations in bifurcation of the cystic duct for surgeons performing laparoscopic cholecystectomy and might be substitute ERCP in preoperative assessment.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1978

Recurrent biliary calculi due to non-absorbable cystic duct ligatures.

A non-absorbable cystic duct ligature may migrate into the common bile duct and act as a nidus for recurrent stone formation. Four case histories are presented and the problem is discussed. This sequel may be prevented by the use of absorbable sutures to ligate the cystic duct, thereby reducing the number of patients facing the hazards of recurrent biliary surgery.

Adult↗
PubMed1991

Reoperation after cholecystectomy. The role of the cystic duct stump.

The so-called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. The aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a long (greater than 1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy in our patients. Three hundred and twenty two patients underwent a second operation on the bile ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking findings was a long cystic duct stump (greater than 1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the only pathological finding. Four years after reoperation this patient is still suffering from the same intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of postcholecystectomy symptoms.

Cholecystostomy↗
PubMed2002

[Method of laparoscopic catheterization of the cystic duct].

During videolaparoscopic operations on bile eliminating pathways when the patent cystic duct is catheterized for cholangiography or drainage of choledochus by the Halsted-Pikovsky method there appear problems with the introduction of the tube into the cystic duct. In order to facilitate the cystic duct catheterization the authors propose to use a fishing-line conductor with the diameter of 0.8-1.0 mm. The method is simple, accessible, facilitates and accelerates the catheterization of the cystic duct and prevents compression of the tube lumen when fixing it with the endoclamp.

Catheterization↗
PubMed1991

The cystic duct sign during morphine-augmented cholescintigraphy.

Visualization of a "dilated cystic duct" during standard hepatobiliary imaging represents a potential source of false-negative cholescintigraphy. Intravenous morphine, commonly used to shorten study time and improve the specificity of hepatobiliary imaging, may, by virtue of its pharmacologic/physiologic actions, accentuate the appearance of a "dilated cystic duct." We present a case of transient cystic duct visualization following morphine administration in a patient with an obstructing cystic duct calculus.

Adult↗
PubMedDate not supplied

Small cell carcinoma of the cystic duct: a case report.

Small cell carcinoma usually involves the lung and rarely affects the biliary tract, especially the cystic duct. In this article we report a case of small cell carcinoma of the cystic duct in a 46-year-old Japanese man. The patient presented with abdominal pain and jaundice. Imaging showed a small nodule in the cystic duct invading the common bile duct with dilatation of the proximal biliary tree. The hepatic artery and portal vein were free from invasion. Extended right hepatic lobectomy, cholecystectomy, and resection of the extrahepatic proximal bile ducts were performed together with lymph node dissection under the tentative diagnosis of carcinoma of the cystic duct. Histopathologic examination of the resected specimen revealed small cell carcinoma arising in the cystic duct and extending into the common bile duct. The postoperative clinical course was uneventful, and the patient is doing well without any signs of recurrence 1 year after the operation. To our knowledge this is the first documented case of a small cell carcinoma arising in the cystic duct.

Bile Duct Neoplasms↗
PubMedDate not supplied

Overlapped-clipping, a new technique for ligation of a wide cystic duct in laparoscopic cholecystectomy.

A wide or enlarged cystic duct is a common encounter in laparoscopic cholecystectomy. Many techniques are used to secure its ligation; including internal or extracorporeal knots and Roeder knot. A preformed knot can be used e.g. ETHIBINDER; the Endoloop. The Endo GIA is a useful stapling device but is more expensive. Other simpler techniques have also been described. The author developed a new, simple, safe and quick technique to ligate the wide cystic duct utilizing the commonly used multiple clip appliers. The technique does not need special skill or instruments and ensures complete ligation of the wide cystic duct using overlapping of the clips.

Adult↗
PubMed1984

Oblique incision of the cystic duct for operative cholangiography.

An oblique incision of the cystic duct is recommended for operative cholangiography. An oblique incision allows good visualization of the cystic duct lumen which is often difficult to see because of the thick mucosa of the cystic duct and the spiral valves of Heister.

Catheterization↗
PubMed1989

Choledochoscopy of the cystic duct as a new approach to the biliary tree.

Operative biliary endoscopy is traditionally performed through a common duct incision, through a very dilated cystic duct lumen. The development of the new ultra thin biliary scopes makes visual examination of the biliary tree possible through a normal cystic duct lumen. The operative approach to the gallbladder is unchanged. The indications for choledochoscopy of the cystic duct are the same as for operative cholangiogram. This examination can be of better quality and is less expensive than an operative roentgenogram. Unlike an operative cholangiogram, which at best visualized the bile ducts, the ultra thin scope gives the surgeon additional information concerning the ampulla of Vater, differentiating ductal spasm from stricture by its tactile feedback through the Bakes-like probe. When disease is present, it is possible for the scope to become a therapeutic instrument without the need for choledochotomy and its associated morbidity and cost. The high incidence of choledocholithiasis in this small series may be attributed to the sample size. It is also possible that more occult stones were found. If this is the case, most of these stones are being passed spontaneously and are never clinically apparent. It is those few patients who have small, occult stones that do not pass who benefit most from this new technology. This study was undertaken to develop and investigate the potential uses of a new biliary scope. These scopes require a learning period before the entire biliary tract can be visualized, but have the potential to be of significant value in the diagnosis and treatment of biliary tract disease.

Biliary Tract Diseases↗
PubMed1979

The problem of the cystic duct remnant.

Symptoms persisting after cholecystectomy for gallbladder disease are often attributed to a long residual cystic duct. Of 30 patients who underwent excision of their cystic duct remnant, 15 were found to have common duct stones which accounted for their symptoms, while an additional four patients had had previous episodes of jaundice which suggested passage of a common duct stone. Those patients with common duct disease in addition to the cystic duct remnant were completely relieved of their symptoms by operation while only eight of the patients without common duct stones obtained relief. A cystic duct remnant infrequently causes symptoms in the absence of pathologic conditions in the common duct.

Adult↗
PubMed1997

An experimental study on effects of occlusion of the cystic duct in mice with or without emptying of the gallbladder.

To study consequences of cystic duct occlusion, 121 NMRI mice were operated: 40 had cystic duct ligature (L group), 41 had cystic duct ligature and evacuation of bile from the gallbladder (LE group), and 40 were sham-operated (S group). Ten mice from each group were sacrificed at 1 week, 1, 3 and 6 months, respectively. All but 2 mice showed signs of wellbeing during the observation time, and weight gain was the same in the three groups. Distended gallbladder occurred in 14 animals, 7 each in the L and the LE group, more frequent after 3 and 6 months. In the remainder mice the gallbladders were smaller than at the time of operation (p < 0.0001). Fibrosis and adhesions around the gallbladder were frequent in the L and the LE groups, and more pronounced in the latter (p = 0.0001). At microscopy there were signs of inflammation in the gallbladder wall in 16 cases in the L group, 28 in the LE group and 2 in the S group, and the degree of inflammation was more pronounced in the LE group than in the L group (p = 0.002). Eleven mice in the LE group had empyema, and slight intralumininal inflammation was more frequent in the LE group than in the L group (p < 0.0001). In conclusion, despite a high incidence of microscopic inflammation the study gave no indication that occlusion of the cystic duct did serious harm to the mice in this series.

Animals↗
PubMed2000

Ligating the cystic duct in laparoscopic cholecystectomy.

BACKGROUND: In laparoscopic cholecystectomy, bile leak from the cystic duct stump is a recognised postoperative complication. This could be due to dislodgement of the metal clips. Migration of the clip is an added problem. METHODS: Since 1995, 70 patients were included in the study of intracorporeal cystic duct ligation in laparoscopic cholecystectomy. Construction of a ligature is a single handed procedure using a free end of the thread. It is quite different from the other two methods described in the literature. RESULTS: There was not a single case of postoperative morbidity in these patients, but in a retrospective study, postoperative biliary dyspepsia with fatty food was evident in a few patients among those cases in which the liga-clips were applied to the cystic duct. CONCLUSION: The cystic duct ligation with absorbable thread should be a gold standard in laparoscopic cholecystectomy. It reduces the risk of postoperative morbidity.

Cholecystectomy, Laparoscopic↗