The cystic duct stump and the postcholecystectomy syndrome. An analysis of 54 patients subjected to ERCP.

Fifty-four symptomatic patients with previous cholecystectomy were subjected to endoscopic retrograde cholangiopancreatography (ERCP) in order to determine the incidence of the cystic duct stump and to study its role in symptomatology. A stump was found in 30 (56%) of the patients, with a mean length of 23 mm (+/- 8.0 SD). The stumps were anatomically classified and 19 belonged to anatomical types where technical difficulties could be expected to be greater than usual at operation. Somatic disease causing the symptoms could be confirmed in 30 cases (56%) abnormality of the biliary tract being the cause in 21 patients (39%). No particular symptoms could be restricted to patients with a cystic duct stump. Total excision of the cystic duct would probably not eliminate the existence of postcholecystectomy symptoms. It does not appear to be necessary to modify the generally accepted method of performing cholecystectomy.