Abstract
BackgroundPrevious gastrectomy can lead to an increased incidence of cholecystocholedocholithiasis (CCL) and increased morbidity rate. However, the appropriate treatment strategy for patients with CCL and a history of gastrectomy remains unclear.MethodsWe performed a retrospective cohort study of patients with CCL and a history of gastrectomy who underwent either one-stage laparoscopic common bile duct (CBD) exploration with stone clearance and laparoscopic cholecystectomy (LCBDE+LC) or two-stage endoscopic retrograde cholangiopancreatography followed by LC (ERCP+LC) from May 2010 to March 2018.ResultsThe success rate of ERCP for CBD stone clearance was 81.2% in patients with a history of Billroth I gastrectomy and 23.7% in patients with a history of Billroth II or Roux-en-Y esophagojejunostomy [χ2 = 97.67, P < 0.001, risk ratio (RR) = 3.43]. The success rate of second-step LC after successful ERCP for removal of CBD stones and the success rate of LCBDE+LC after ERCP treatment failure were 96.8 and 87.7%, respectively, in patients with preoperative intra-abdominal adhesion evaluation scores of ≤3 points. These success rates were 28.6 and 27.6%, respectively, in patients with scores of > 3 points (χ2 = 59.70, P < 0.001, RR = 3.38 and χ2 = 53.41, P < 0.001, RR = 3.27, respectively).ConclusionsBased on the results of this study, ERCP+LC seems to be an attractive strategy for treatment of CCL in patients with a history of Billroth I gastrectomy, and LCBDE+LC appears to be suitable for patients with a history of Billroth II or Roux-en-Y esophagojejunostomy. Preoperative evaluation of intra-abdominal adhesions helps to reduce the conversion rate of laparoscopic surgery.
Highlights
Previous gastrectomy can lead to an increased incidence of cholecystocholedocholithiasis (CCL) and increased morbidity rate
Many studies have proven that Laparoscopic common bile duct exploration (LCBDE)+laparoscopic cholecystectomy (LC) is both feasible and effective in the management of CCL [22, 23], one retrospective cohort study performed in the United States showed that the overall use of endoscopic retrograde cholangiopancreatography (ERCP)+LC for treatment of CCL increased from 52.8% of admissions in 1998 to 85.7% in 2013 and that the percentage of patients with CCL undergoing common bile duct exploration (CBDE) decreased from 39.8 to 8.5% in the same period. These results indicate that despite the potential benefits of LCBDE+LC over endoscopic retrograde cholangiopancreatography followed by LC (ERCP+LC) for managing CCL, the current trends in CCL management continue, and CBDE may be at risk of disappearing from the surgical armamentarium [24]
We selected gastroenteric anastomosis as the candidate risk factor and conducted a retrospective cohort study from May 2010 to March 2018, and we found that patients with a history of Billroth I gastrectomy have a higher success rate of ERCP for clearance of common bile duct (CBD) stones and that ERCP might be the first choice to treat choledocholithiasis in these patients
Summary
Previous gastrectomy can lead to an increased incidence of cholecystocholedocholithiasis (CCL) and increased morbidity rate. The appropriate treatment strategy for patients with CCL and a history of gastrectomy remains unclear. Treatment options for cholecystocholedocholithiasis (CCL) include two-stage endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) (i.e., ERCP+LC), one-stage laparoscopic common bile duct exploration (CBDE) and LC (i.e., LCBDE+LC), and laparotomic CBDE and cholecystectomy [1, 2]. Zhang et al BMC Surgery (2018) 18:54 treatment strategies for patients with CCL and a history of gastrectomy
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