A Prospective Study of Common Bile Duct Calculi in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Choledocholithiasis occurs in 3.4% of patients undergoing laparoscopic cholecystectomy but more than one third of these pass the calculi spontaneously within 6 weeks of operation and may be spared endoscopic retrograde cholangiopancreatography. Treatment decisions based on assessment by operative cholangiography alone would result in unnecessary interventions in 50% of patients who had either false positive studies or subsequently passed the calculi. These data support a short-term expectant approach in the management of clinically silent choledocholithiasis in patients selected for LC.

Common bile duct stones — their presentation, diagnosis and management

“…Twelve of these had a normal cholangiogram at 48 hours (26% possible false positive operative cholangiogram) and a further 12 at 6 weeks (26% spontaneous passage of calculi) [56]. Spontaneous passage was not determined by either the number or size of calculi or by the diameter of the bile duct.…”

“…Echoing this advice in a series of 997 patients [56] in whom IOC was accomplished in 962 patients (96%), 46 patients (4.6%) had at least one fi lling defect. Twelve of these had a normal cholangiogram at 48 hours (26% possible false positive operative cholangiogram) and a further 12 at 6 weeks (26% spontaneous passage of calculi) [56].…”

“…Spontaneous passage was not determined by either the number or size of calculi or by the diameter of the bile duct. Only 22 patients (2.2% of total population) had persistent CBD calculi at 6 weeks after laparoscopic cholecystectomy and retrieved by endoscopic retrograde cholangiopancreatography [56]. Treatment decisions based on assessment by operative cholangiography alone would result in unnecessary interventions in 50% of patients who had either false positive studies or subsequently passed the stone [56].…”

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

“…Of the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic…”

“…These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic…”