Evaluation of the Common bile duct (CBD) Diameter After Laparoscopic Cholecystectomy (LC) and Laparoscopic Common Bile Duct Exploration (LCBDE)

Abstract

Background: Common Bile duct (CBD) measurement is a crucial aspect in the evaluation of the biliary tree. Whether the CBD undergoes any compensatory change in diameter after laparoscopic cholecystectomy or laparoscopic common bile duct exploration is still up for discussion. The aim of this study was to investigate CBD diameter changes after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) on magnetic resonance cholangiopancreatography (MRCP).Materials and Methods: Our retrospective study is divided into 2 sections. The first part assessing CBD diameter changes after laparoscopic cholecystectomy due to gallstones or gallbladder polyps, involved 85 patients, who underwent MRCP procedures. These patients aged between 30 and 85 were divided into an interval LC group (group A, n = 56) and a remote LC group (group B, n = 29). In group A, the common CBD diameters were measured at their widest portions on MRCP obtained before and after laparoscopic cholecystectomy. Measurements of the CBD diameters were repeated on MRCP obtained twice after the surgery in group B. Section 2 consisted of 38 patients who had choledocholithiasis and were treated with laparoscopic CBD exploration and T-tube placement. These patients aged 26 to 86 formed the interval LCBDE group (group C). The CBD widest diameters were measured on MRCP before LCBDE and after T-tube cholangiography for these individuals. Patients in groups A and C were further divided into 5 and those in group B into 4 age-related subgroups to facilitate statistical analysis. The Pearson correlation test was performed to find any relationship between CBD diameters and age in groups A and B. Paired sample T test was used to compare the significant difference between the 2 sets of CBD diameters in each study group and their subgroups.Results: In the interval LC group, the post-LC mean CBD diameter was significantly wider when compared with the preoperative mean diameter (P < 0.05). There was a significant difference between the first and second post-LC means CBD diameter in the remote LC group (P < 0.05). In group C, the mean CBD diameter measured on T-tube cholangiography after LCBDE was significantly smaller than the preoperative dilated mean diameter (P < 0.05).Conclusions: This study demonstrated significant dilation occurring in the common bile duct diameter after laparoscopic cholecystectomy. Furthermore, our remote LC group also supported that claim by showing significant dilation between the first and second post-cholecystectomy CBD diameter values. And lastly, our interval LCBDE sample's initial dilation of the CBD diameters was reduced after surgery and stone extraction.

Magnetic Resonance Cholangiopancreatography: Diagnostic Role in Evaluating Pancreaticobiliary Abnormalities

“…This coped with what was mentioned by Park et al, (10) that a CBD dilatation within 10 mm in gallbladder resected patients can be regarded as normal physiological change. The results also kept up with what was stated by Pallaneeandee et al, (11) that this post-cholecystectomy dilatation can be attributed to compensatory adaptation of the CBD in the absence of the gallbladder. In our study, biliary stones weren't only detected in GB but also in CBD and hepatic ducts (group III patients).…”

Efficacy and safety of double endoscopy combined with exploration in the treatment of elderly patients with cholecystolithiasis complicated with choledocholithiasis

“…Studies have shown that a high stone removal rate can be attributed to the use of choledochoscopy, electrohydraulic lithotripsy (EHL), and a balloon dilation system [ 15 ]. Although intraoperative ultrasound and cholangiography are helpful in the detection of common bile duct stones [ 18 , 19 ], EHL and laser lithotripsy can significantly improve the stone removal rate. However, residual stones inevitably present in a small number of patients.…”

Clinical efficacy of laparoscopic cholecystectomy plus cholangioscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

“…The relatively high risk of postoperative complications related to ERCP + LC may be due to the sphincter of Oddi incision during the surgical procedure, which may cause changes in the biliary tract structure that negatively affect the natural defense mechanism of the bile duct, leading to adverse events, such as pancreatitis, hyperamylasemia, BTI, and bile leakage[ 22 , 23 ]. The LC + LCBDE approach, as a one-time operation, circumvents the high surgical risk of two procedures in the ERCP + LC approach and preserves duodenal papilla function, thus avoiding the structural changes to the bile duct related to the papillotomy and infections caused by retrograde flow of intestinal juice[ 24 , 25 ].…”