Anterograde Tracing Along Cystic Duct Method To Prevent Stump Cholecystitis In Laparoscopic Cholecystectomy

Objective: To investigate the efficacy,safety and feasibility of the anterograde tracing along cystic duct method to prevent stump cholecystitis in laparoscopic cholecystectomy through retrospective study of the incidence of postoperative stump cholecystitis,bile duct injury,bile leakage and common bile duct stone residue.Methods:1.All cases of stump cholecystitis treated at the Department of Hepatobiliary Surgery of Yijishan Hospital,Wanan Medical College from September 2018 to August2020 were collected and classified according to four subtypes: residual gallbladder without stones,residual cystic duct alone,residual gallbladder with stones,and residual cystic duct with stones.The disease proportion is used to indicate the probability of stump cholecystitis occurring in patients undergoing cholecystectomy in the same period.To compare the differences in indicators of postoperative biliary tract injury,bile leakage,time of operation,operation conversion rate,duration of postoperative hospital stay and bleeding volume during operation between cholecystectomy and residual cholecystectomy in the same period.2.The data of all cases in which the gallbladder was excised by the anterograde tracing along cystic duct method at the Department of Hepatobiliary Surgery,Yijishan Hospital,Wanan Medical College from the same term were collected,as the study group.the data of cases in which the gallbladder was excised by the non-anterograde tracing free method were recorded after reviewing the literature.the non-anterograde tracing free method were used as the control group.To compare the differences in indicators of postoperative biliary tract injury,common bile duct residual stones,bile leakage and postoperative stump cholecystitis between the two groups.Results:1.a total of 818 cases of laparoscopic cholecystectomy were collected.another 10 cases of stump cholecystitis were collected,7 cases of residual cystic duct(6 with stones)and 3 cases of residual gallbladder(3 with stones).and the proportion of stump cholecystitis was 1.22%.residual cholecystectomy was performed in all patients with stump cholecystitis.the completion rate of laparoscopic surgery was 90%.the average operative time was 111(60-240)min,average length of stay after surgery was 6.1(3-12)day,and the average blood loss was 26(10-50)ml.no bile duct injury was observed in patients with non-residual cholecystectomy and residual cholecystectomy.The difference of bile leakage was not statistically significant between residual cholecystectomy and non-residual cholecystectomy(P > 0.05).non-residual cholecystectomy had a lower incidence of time of operation,operation conversion rate,duration of postoperative hospital stay and bleeding volume during operation than the residual cholecystectomy,the difference was statistically significant(P < 0.05).2.In the syudy group,818 patients who had their laparoscopic cholecystectomy.laparoscopic cholecystectomy was performed in 816 cases.There were 2 cases of conversion to laparotomy,the completion rate of laparoscopic surgery was 99.8%.the average operative time was 61.1(20-255)min,average length of stay after surgery was2.31(1-13)day,and the average blood loss was 8.6(2-100)m L.2 cases of mirizzi’s syndrome,1 case of double cholecystic duct malformation and 5 cases of other types of bile duct variation,0 patients with stump cholecystitis were identified.2 cases had bile leaks which healed after drainage,Healing after puncture or original drainage tube drainage.1 case had a postoperative residual common bile duct stone,the patient performed an ERCP to retrieve the stone.In the control group,and 0 patients with stump cholecystitis and bile duct injury were identified.272 of the 1374 patients with gallstone disease with post-cholecystectomy syndrome.22 cases of common bile duct stones,19 cases of bile leakage,11 cases of stump cholecystitis,and no bile duct injury was reported,No bile duct injury was reported in either group,the study group had a lower incidence of stump cholecystitis,bile leakage and common bile duct residual stones than the control group,the difference was statistically significant(P < 0.05).Conclusion: Anterograde tracing along cystic duct method can effectively prevent the occurrence of stump cholecystitis,which is safe,feasible and simple to operate,and can be used as a supplement to other preventive methods.