Risk factors of recurrence following common bile duct exploration for choledocholithiasis

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.

Ultrasound‐Guided Percutaneous Transhepatic Cholangioscopic Lithotripsy for the Treatment of Common Bile Duct Stones and Analysis of Risk Factors for Recurrence

“…This is because gallstones have a propensity to migrate into the CBD and block the flow of bile. This disrupted flow hinders the effective clearance of all stones, resulting in the presence of residual small stones within the duct and subsequently leading to CBD stone formation [18, 19]. In this study, the LCBDE group had the lowest recurrence rate of CBDS, which could be attributed to the concurrent performance of cholecystectomy.…”

Recurrence of common bile duct stones after choledocholithotomy in elderly patients: risk factor analysis and clinical prediction model development

“…A history of cholecystectomy, WBC count ≥11.0 × 10 9 /L, preoperative TBIL level ≥ 36.5 mmol/L, number of stones ≥2, maximum stone diameter ≥ 0.85 cm, and T-tube drainage were independent risk factors affecting CBDS recurrence in elderly patients after choledocholithotomy. A history of cholecystectomy and the placement of a T-tube drainage catheter are independent risk factors as compared to other factors and have been rarely reported as significant factors of CBDS recurrence in previous studies ( 2 , 13 , 23 ).…”

“…Improper placement of the T-tube can lead to the twisting or bending of the CBD, while prolonged T-tube drainage can increase the risk of bacterial infections within the bile duct, which may contribute to the high recurrence rate of CBDS. It is worth noting that when surgeons suspect the potential recurrence of CBDS after surgery, they often choose to place a T-tube, which may lead to selection bias ( 23 ).…”

Case report of choledocholithiasis 40 years post cholecystectomy

“…Presentation later than that is thought to be secondary to migratory surgical clips as it acts as a nidus for stone formation. There are studies that revealed common bile duct (CBD) stones formation is associated with bile duct stricture, periampullary diverticulum, parasites or foreign bodies within bile duct or other factors that can cause bile stasis [8] . Current evidence suggests endoscopic ultrasound or magnetic resonance cholangiopancreatography as the investigation of choice for CBD stones however CT scan is important in looking for features of CBD stone, malignancy coexisting and to investigate for other causes of abdominal pain [9] .…”