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Management of bile duct stones at cholecystectomy: an Australian single-centre experience over 2 years

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Abstract

Background

Bile duct stones with an intact gallbladder can be treated with either bile duct exploration at cholecystectomy or endoscopic retrograde cholangiopancreatography (ERCP) before or after cholecystectomy. The aim of this study was to evaluate the management of bile duct stones at cholecystectomy at our institution. We also aimed to identify risk factors for failure of ductal clearance in our series.

Methods

A retrospective review of 690 laparoscopic cholecystectomies over a 2-year period was performed. Patients who underwent laparoscopic bile duct exploration formed the study population.

Results

Of 69 patients with suspected bile duct stones at cholecystectomy 67 (97%) patients underwent laparoscopic bile duct exploration upfront. Complete ductal clearance was achieved in 52 (78%) patients. Postoperative complications (10/67, 15%) included postoperative bleeding (2/67, 3%), bile leak (1/67, 1%), and superficial wound infection (1/67, 1%). There was no mortality. The mean operative time was 126 min and the median length of stay was 2 (1–4) days. A wider common bile duct (CBD) (≥ 8 mm) increased the risk of failed ductal clearance (OR 4.50; 95% confidence interval (CI) 1.15–19.23).

Conclusion

This study found that laparoscopic bile duct exploration can effectively and safely treat bile duct stones suspected at cholecystectomy.

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Acknowledgements

We thank Dr Ian Hughes (Office of Research Governance and Development, Gold Coast Health) for assistance in statistical analyses.

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Authors and Affiliations

  1. Department of Surgery, Gold Coast University Hospital, Southport, QLD, Australia

    Kihoon Choi

  2. School of Medicine, University of Queensland, Herston, QLD, Australia

    Tehan Amarasena

  3. Department of General Surgery, The Prince Charles Hospital, Chermside, QLD, Australia

    Andrew Hughes, Ian Shaw, Harish Iswariah, Diana Tam, Robert Franz & Manju Chandrasegaram

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  1. Kihoon Choi
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  2. Tehan Amarasena
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  4. Ian Shaw
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  8. Manju Chandrasegaram
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Correspondence to Kihoon Choi.

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Kihoon Choi, Tehan Amarasena, Andrew Hughes, Ian Shaw, Harish Iswariah, Diana Tam, Robert Franz and Manju Chandrasegaram have no conflicts of interest or financial ties to disclose.

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Choi, K., Amarasena, T., Hughes, A. et al. Management of bile duct stones at cholecystectomy: an Australian single-centre experience over 2 years. Surg Endosc 35, 1247–1253 (2021). https://doi.org/10.1007/s00464-020-07495-7

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  • DOI: https://doi.org/10.1007/s00464-020-07495-7

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