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Assessment of postoperative common bile duct stones after endoscopic extraction and subsequent cholecystectomy

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Abstract

Background

Common bile duct stones (CBDSs) occasionally cause serious diseases, and endoscopic extraction is the standard procedure for CBDS. To prevent biliary complications, cholecystectomy is recommended for patients who present with gallbladder (GB) stones after endoscopic CBDS extraction. However, CBDS can occasionally recur. To date, the occurrence of CBDS after endoscopic CBDS extraction and subsequent cholecystectomy is not fully understood. Hence, the current study aimed to evaluate the incidence of postoperative CBDSs.

Methods

This retrospective observational study included consecutive patients who underwent postoperative endoscopic retrograde cholangiography after endoscopic CBDS extraction and subsequent cholecystectomy between April 2012 and June 2021 at our institution. After endoscopic CBDS extraction, a biliary plastic stent was inserted to prevent obstructive cholangitis. Endoscopic retrograde cholangiography was performed to evaluate postoperative CBDSs after cholecystectomy until hospital discharge. The outcomes were the incidence of postoperative CBDSs and CBDSs/sludge. Moreover, the predictive factors for postoperative CBDSs were evaluated via univariate and multivariate analyses.

Results

Of eligible 204 patients, 52 patients (25.5%) presented with postoperative CBDSs. The incidence rate of CBDS/sludge was 36.8% (n = 75). Based on the univariate analysis, the significant predictive factors for postoperative CBDSs were ≥ 6 CBDSs, presence of cystic duct stones, and ≥ 10 GB stones (P < 0.05). Moreover, male sex and < 60-mm minor axis in GB might be predictive factors (P < 0.10). Based on the multivariate analysis, ≥ 6 CBDSs (odds ratio = 6.65, P < 0.01), presence of cystic duct stones (odds ratio = 4.39, P < 0.01), and ≥ 10 GB stones (odds ratio = 2.55, P = 0.01) were independent predictive factors for postoperative CBDSs.

Conclusions

The incidence of postoperative CBDS was relatively high. Hence, patients with predictive factors for postoperative CBDS must undergo imaging tests or additional endoscopic procedure after cholecystectomy.

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Authors and Affiliations

  1. Department of Gastroenterology, Hokkaido Gastroenterology Hospital, 1-2-10, 1-jo Honcho, Higashi-ku, Sapporo, Japan

    Ryo Sugiura, Hideaki Nakamura, Shoichi Horita, Takashi Meguro, Kiyotaka Sasaki, Hidetoshi Kagaya, Tatsuya Yoshida & Hironori Aoki

  2. Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Ryo Sugiura, Masaki Kuwatani & Naoya Sakamoto

  3. Department of Gastroenterological Surgery, Hokkaido Gastroenterology Hospital, Sapporo, Japan

    Takayuki Morita, Miyoshi Fujita, Eiji Tamoto, Masayuki Fukushima, Yoshitomo Ashitate, Takashi Ueno & Akio Tsutaho

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  1. Ryo Sugiura
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  2. Hideaki Nakamura
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  14. Takashi Ueno
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Corresponding author

Correspondence to Ryo Sugiura.

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Drs. Ryo Sugiura, Hideaki Nakamura, Shoichi Horita, Takashi Meguro, Kiyotaka Sasaki, Hidetoshi Kagaya, Tatsuya Yoshida, Hironori Aoki, Takayuki Morita, Miyoshi Fujita, Eiji Tamoto, Masayuki Fukushima, Yoshitomo Ashitate, Takashi Ueno, Akio Tsutaho, Masaki Kuwatani, and Naoya Sakamoto have no conflict of interest or financial ties to disclose.

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Sugiura, R., Nakamura, H., Horita, S. et al. Assessment of postoperative common bile duct stones after endoscopic extraction and subsequent cholecystectomy. Surg Endosc 36, 6535–6542 (2022). https://doi.org/10.1007/s00464-022-09017-z

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  • DOI: https://doi.org/10.1007/s00464-022-09017-z

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