A nomogram for predicting stones recurrence in patients with bile duct stones undergoing laparoscopic common bile duct exploration

Abstract

Background The recurrence of bile duct stones is a long‐term outcome for patients undergoing laparoscopic common bile duct exploration (LCBDE) that is worthy of attention. This study aimed to investigate long‐term risk factors for stones recurrence after LCBDE and develop a nomogram for predicting the risk. Methods The clinical data on consecutive patients with bile duct stones undergoing LCBDE at Shanghai Tenth People's Hospital between January 2014 and February 2019 with a follow‐up period longer than 2 years were reviewed. Independent risk factors of stones recurrence identified by the Cox regression model were used to develop a nomogram in predicting stones recurrence after LCBDE. Results Eight hundred and twenty‐two patients were eventually included in this study. Of these patients, 42 (5.11%) developed stones recurrence. The cumulative incidences of stones recurrence at 1, 3, and 5 years after LCBDE were 1.34%, 4.36%, and 7.14%, respectively. Independent risk factors of stones recurrence were identified to be age (HR = 1.04, 95% CI = 1.02‐1.07), T‐tube drainage (HR = 3.28, 95% CI = 1.23‐8.72), fatty liver (HR = 2.69, 95% CI = 1.39‐5.20), urinary calculus (HR = 4.68, 95% CI = 2.29‐9.56), post‐cholecystectomy (HR = 5.21, 95% CI = 2.39‐11.33), and post‐ERCP + EST (HR = 2.87, 95% CI = 1.18‐6.96). By these factors, a developed nomogram showed a C‐index of 0.770 to predict stones recurrence. Conclusions The nomogram, based on identified risk factors, showed good accuracy for predicting stones recurrence, which is valuable to guide these patients’ follow‐up and prevention.

Is T-tube drainage no longer needed for laparoscopic common bile duct exploration? A retrospective analysis and literature review.

“…Additionally, PC can achieve the same rate of postoperative bile leakage and stone clearance compared with TTD and avoid the disadvantages associated with TTD [ 18 , 19 ]. Exceptionally, our study demonstrated for the first time that primary closure would reduce the recurrence rate of bile duct stones and the T-tube is a potential factor that promotes stone formation [ 14 , 23 ].…”

“…The operative technique for LCBDE was as described previously, using the “four-port and six-step” approach under general anesthesia [ 14 , 15 ]. Briefly, after successfully dissecting Calot’s triangle, the cystic duct was isolated and clamped with an absorbable clip (Lapro-Clip; Tyco Healthcare, Covidien, Norwalk, Conn., USA), which prevented the gallbladder stones sliding into the CBD during the operation.…”