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Surgical Treatment for Choledocholithiasis Following Repeated Failed Endoscopic Retrograde Cholangiopancreatography

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is the first line treatment for choledocholithiasis. In many occasions, several attempts of ERCP are performed until failure is declared and surgical treatment is applied, in many times following procedure-related complications. We present the results of surgical management of patients with choledocholithiasis following repeated failures of ERCP due to impaction of multiple large stones.

Methods

Patients that underwent surgical treatment for choledocholithiasis following repeated ERCP attempts between January 2006 and December 2018 were retrospectively assessed. Post-ERCP complications were evaluated and the surgical approach, technique, and outcomes were assessed.

Results

One hundred and two patients were operated on for choledocholithiasis following repeated failed ERCP. All the patients had at least 2 failed attempts (mean = 3.2 ± 1.7), and 25 (23.5%) suffered major ERCP-related complications. Following choledochotomy and stone extraction, bilioenteric anastomosis was done in the vast majority of patients (90.2%), most commonly choledochoduodenostomy (62%). Thirty-eight (37%) patients had minimally invasive procedure (laparoscopic n = 26, robotic assisted n = 12). Major post-operative complications (Clavien-Dindo ≥ 3) occurred in 24 patients (23.5%). Nine patients (8.8%) were re-operated and 10 (9.8%) were readmitted within 30 days from surgery. Three patients died within 30 days from surgery. Older patients had significantly more ERCP attempts and suffered higher post-operative mortality. During a median follow-up of 70 months, the only biliary complication was an anastomotic stricture in one patient.

Conclusion

Surgery for CBDS after failure of ERCP is safe and provides a highly effective long-term solution.

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Authors and Affiliations

  1. Division of General Surgery, Department of General Surgery B, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Muhammad Younis, Reut El-On, Nir Lubezky & Yaacov Goykhman

  2. Department of General Surgery and Transplantation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer, 52621, Ramat-Gan, Israel

    Niv Pencovich & Ido Nachmany

  3. Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Adam Phillips

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Contributions

MY — study conception and design, acquisition of data, revising the draft critically for important intellectual content.

NP — drafting of manuscript, analysis, and interpretation of data.

REO — acquisition of data, revising the draft critically for important intellectual content.

NL — acquisition of data, revising the draft critically for important intellectual content.

YG — acquisition of data, revising the draft critically for important intellectual content.

AP — acquisition of data, revising the draft critically for important intellectual content.

IN — study conception and design, critical revision of manuscript.

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Correspondence to Niv Pencovich.

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The authors declare no competing interests.

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Muhammad Younis and Niv Pencovich contributed equally to this work.

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Younis, M., Pencovich, N., El-On, R. et al. Surgical Treatment for Choledocholithiasis Following Repeated Failed Endoscopic Retrograde Cholangiopancreatography. J Gastrointest Surg 26, 1233–1240 (2022). https://doi.org/10.1007/s11605-022-05309-w

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  • DOI: https://doi.org/10.1007/s11605-022-05309-w

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