J Minim Invasive Surg.  2021 Mar;24(1):43-50. 10.7602/jmis.2021.24.1.43.

Risk factors of recurrence following common bile duct exploration for choledocholithiasis

Affiliations
  • 1Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea
  • 2Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
  • 3Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea

Abstract

Purpose
The purpose of this study was to investigate the recurrence factors of choledocholithiasis after common bile duct (CBD) exploration.
Methods
From January 2000 to December 2018, we retrospectively reviewed 253 patients who underwent CBD exploration surgery. We excluded 100 cases who had residual stone, combined major surgery, or follow-up loss after surgery. Total of 153 patients were included, and we investigated the recurrence factors of choledocholithiasis. Various variables such as patients’ demographics, gallstones, preoperative endoscopic treatment, and laboratory data were analyzed to find factors related to recurrent choledocholithiasis.
Results
The median follow-up period was 20.6 months (range 4.7–219 months), and 27 patients (17.6%) had experienced recurrent choledocholithiasis. Univariate analysis showed that the following variables were associated with recurrence of choledocholithiasis; preoperative leukocytosis (white blood cell ≥ 11,000/µL), open procedure, T tube insertion, long hospital duration, and long operation time. Logistic regression multivariate analysis identified preoperative leukocytosis (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.21–9.73; p = 0.021), open procedure (OR, 5.54; 95% CI, 4.73–6.35; p = 0.037), and T-tube insertion (OR, 2.82; 95% CI, 1.04–7.65; p = 0.042) as independent predictors of recurrent choledocholithiasis.
Conclusion
Because of delayed recurrence of choledocholithiasis, it is recommended to continue follow-up of patients after CBD exploration surgery. Laparoscopic surgery was observed to be associated with a reduction in recurrence. The preoperative leukocytosis and clinical conditions in which open surgery is performed could be associated with recurrence of choledocholithiasis. However, further study is necessary to validate the result.

Keyword

Common bile duct; Gall stones; Recurrence; Risk factors; Laparoscopic cholecystectomy
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