Ann Surg Treat Res.  2016 Nov;91(5):239-246. 10.4174/astr.2016.91.5.239.

Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis

• Lee DH
• Ahn YJ
• Lee HW
• Chung JK
• Jung IM

• KMID: 2356374
• DOI: http://doi.org/10.4174/astr.2016.91.5.239

Abstract

PURPOSE
To investigate the prevalence and clinical features of retained symptomatic common bile duct (CBD) stone detected after laparoscopic cholecystectomy (LC) in patients without preoperative evidence of CBD or intrahepatic duct stones.
METHODS
Of 2,111 patients who underwent cholecystectomy between September 2007 and December 2014 at Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 1,467 underwent laparoscopic cholecystectomy for symptomatic gallbladder stones and their medical records were analyzed. We reviewed the clinical data of patients who underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) for clinically significant CBD stones (i.e., symptomatic stones requiring therapeutic intervention).
RESULTS
Overall, 27 of 1,467 patients (1.84%) underwent postoperative ERCP after LC because of clinical evidence of retained CBD stones. The median time from LC to ERCP was 152 days (range, 60-1,015 days). Nine patients had ERCP-related complications. The median hospital stay for ERCP was 6 days.
CONCLUSION
The prevalence of clinically significant retained CBD stone after LC for symptomatic cholelithiasis was 1.84% and the time from LC to clinical presentation ranged from 2 months to 2 years 9 months. Therefore, biliary surgeons should inform patients that retained CBD stone may be detected several years after LC for simple gallbladder stones.

Keyword

Gallstones; Laparoscopic cholecystectomy; Morbidity

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Cholecystectomy, Laparoscopic*
Cholelithiasis*
Common Bile Duct*
Gallbladder
Gallstones
Humans
Length of Stay
Medical Records
Prevalence*
Seoul
Surgeons

Figure

• 

  Fig. 1 Flowchart of the selection for patients. GB, gallbladder; CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; USG, ultrasonography.

• 

  Fig. 2 Institutional guideline of preoperative and postoperative management of the patient who has abdominal symptoms suspecting cholelithiasis. USG, ultrasonography; GB, gallbladder; CBD, common bile duct; ERCP, endoscopic retrograde cholangiopancreatography; MRCP, magnetic resonance cholangiopancreatography; LFT, liver function test; FU, follow-up.

• 

  Fig. 3 The time interval from laparoscopic cholecystectomy to endoscopic retrograde cholangiopancreatography.

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