Why is There Recurrence After Transcystic Laparoscopic Bile Duct Clearance? Risk Factor Analysis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2009 Mar 6

PMID 19263129

Citations 16

Authors

A Bove

G Bongarzoni

G Palone

R M Di Renzo

E M Calisesi

L Corradetti

M Di Nicola

L Corbellini

Affiliations

Soon will be listed here.

Abstract

Aim: Incidence of common bile duct stones (CBDS) is approximately 10% in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy. Transcystic laparoscopic common bile duct exploration (TC-CBDE) is safe and efficient in achieving bile duct clearance from stones, with a success rate of between 85% and 95%. The aim of this retrospective study is the evaluation of risk factors and recurrence in patients treated with TC-CBDS.

Methods: From October 2003 until September 2007, 110 consecutive patients with common bile duct stones and gallbladder were included in the study. Average age was 64 years (range 21-82 years). The procedure was completed laparoscopically in 106 patients (96.4%): with TC-CBDE in 90 patients (85%), who are the object of this study; and with TC-CBDE + perioperative guide wire papillotomy ("rendezvous") in 16 cases (15%). In the 90 patients treated with TC-CBDE which we examined, the risk factors were: preoperative liver function tests, diameter of the common bile duct (normal 8 mm or less), number of stones (<or=3 or more), presence of stones with biliary sludge, and pre- or intraoperative diagnosis. Student's test was used for statistical analysis with a P value of < 0.05 defined as statistically significant.

Result: The conversion rate to open surgery was 3.6%. There were no mortalities. The average operative time was 115.6 min. The morbility rate was 7.7% with 4.8% local complications and 2.9% general complications. Average follow-up on 90 patients (after TC-CBDE) was 28 months (range 4.2-48 months). We found six recurrences (6.7%). The statistic analysis showed that only number of stones >3 with biliary sludge predicted a recurrence (p < 0.05) while the other factors did not show important clinical variables.

Conclusion: TC-CBDE is safe and effective in the majority of cases of CBDS. The incidence of recurrence is low but there are some risk factors, such as number of stones >3 with biliary sludge, which do not favor the successful outcome of the procedure. In such cases, it is essential that the TC-CBDE is integrated with other procedures which, although more complex, assure the clearance of the bile duct.

Citing Articles

Predictors for stone recurrence after a successful common bile duct surgical exploration for choledocholithiasis.

Gonzalvez-Guardiola P, Paya-Llorente C, Pozo C, Martinez-Perez A Langenbecks Arch Surg. 2022; 407(4):1545-1552.

PMID: 35670858 DOI: 10.1007/s00423-022-02577-7.

A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy?.

Donnellan E, Coulter J, Mathew C, Choynowski M, Flanagan L, Bucholc M Surg Open Sci. 2021; 3:8-15.

PMID: 33937738 PMC: 8076912. DOI: 10.1016/j.sopen.2020.07.004.

Advances in Risk Factors for Recurrence of Common Bile Duct Stones.

Wu Y, Xu C, Xu S Int J Med Sci. 2021; 18(4):1067-1074.

PMID: 33456365 PMC: 7807200. DOI: 10.7150/ijms.52974.

How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?.

Bove A, Panaccio P, Di Renzo R, Palone G, Ricciardiello M, Ciuffreda S Gastroenterol Rep (Oxf). 2019; 7(4):258-262.

PMID: 31413832 PMC: 6688737. DOI: 10.1093/gastro/goz022.

Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies.

Fang L, Wang J, Dai W, Liang B, Chen H, Fu X Surg Endosc. 2018; 32(12):4742-4748.

PMID: 30298446 DOI: 10.1007/s00464-018-6195-z.

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