Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low Risk of Common Duct Stones: Can It Be Beneficial?

BACKGROUND: Gallstone disease affects 15–20% of the general population and up to 20% of these patients present common bile duct stones. AIM: This observational study reports our experience on routine cysticotomy and flushing of the cystic duct in patients with low risk of common duct stones. MATERIALS AND METHODS: We analyzed 731 patients who underwent laparoscopic cholecystectomy between September 2013 and September 2015. RESULTS: Patients were preoperatively stratified on the clinical risk; those presenting with low preoperative risk of common bile duct stones were referred to undergo laparoscopic cholecystectomy and routine cysticotomy with bile duct flushing. Patients presenting thick bile sludge, solid debrides, and/or increased tension of bile outflow underwent unplanned cholangiography. No intraoperative complications or conversion to open technique occurred. Average follow-up time was 22,8 months (range 12 to 37). Rate of retained ductal stones accounted for 0,3%. CONCLUSIONS: Routine cysticotomy and bile flushing in our experience is a valid, simple, and not time consuming manoeuvre that can help decompressing and flushing CBD. Moreover, it is a valid tool for extending selective IOC approach in a focused manner. Further evaluations have to be conducted to evaluate risks and effectiveness of this manoeuvre.