Is Biliary Lithogenesis Affected by Length and Implantation of Cystic Duct? (Study of 270 Patients with Endoscopic Retrograde Cholangiopancreatography)

The gallbladder seems to play an important rolein lithogenesis. Moreover, the morphology and theimplantation of the cystic duct may also influence thisprocess. Our purpose was to evaluate if the length and the implantation of the cystic duct mayaffect the formation of gallstones. Between April 1992and March 1994, 270 patients who underwent endoscopicretrograde cholangiopancreatography were included in the study, and the radiological length ofthe cystic duct was carefully recorded. Patients weredivided into two groups: I, absence of lithiasis: 113patients (65 men, 48 women); and II, gallbladder lithiasis or lithiasis in the common bile ductwith or without gallbladder lithiasis: 157 patients (73men, 84 women). A statistically significant differencewas observed among the two groups regarding the insertion of the cystic duct: implantationon the left side of the common bile duct represented arisk factor of lithiasis. The length of the cystic ductwas not directly implicated. Hypokinesis of the gallbladder is currently recognized asbeing a major factor in the initial steps oflithogenesis, but the implantation of the cystic ductcan play an important role by increasing cystic ductresistance and causing a reduced washout effect of thegallbladder contents, including cholesterolcrystals.