Common Bile Duct (CBD) exploration for patients with unsuspecting choledocholithiasis - a ten-year study of outcomes

Abstract

Introduction: Cholecystectomy is one of the most common general surgery operations performed world-wide. A proportion of patients who undergo cholecystectomy (laparoscopic or open) also have concurrent stone disease within the biliary tree requiring bile duct exploration at time of operation. The aim of our study was to review the outcomes of patients with unsuspected choledocholithiasis who underwent CBD exploration at Northern Health. Method: CBD exploration is the standard treatment for patients with choledocholithiasis at Northern Health. An on-call service with 5 available surgeons performs explorations using a choledochoscope. A retrospective audit of patients who underwent CBD exploration for the management of choledocholithiasis between 2008 and 2018 was performed. Analysis was undertaken on factors suspicious for choledocholithiasis, patient demographics and operative features. Result: 6499 patients underwent cholecystectomy in the 10-year period, of which 604 (9.3%) underwent CBD exploration. Unsuspected choledocholithiasis represents 27% of CBD explorations (n = 163). Compared to patients with suspected choledocholithiasis, patients with unsuspected choledocholithiasis are more likely to be younger (median age of 44 vs 51, p=.037), female (75.5% vs 61%, p=.001) and an elective admission (35.9% vs 11.6%, p<.001). Patients with unsuspected choledocholithiasis have similar success rates (93.9% vs 89.8%, p=ns) and surgical times (median 165 vs 163 minutes, p=ns), but reduced length of stay (4 vs 5 days, p<.001) and fewer minor complications (3.1% vs 9.3%, p=.005). Conclusion: Unsuspected choledocholithiasis contributes to a significant proportion of patients who require CBD exploration for the management of choledocholithiasis. Given the success rate, length of stay and low rate of complications, proceeding to CBD exploration should be considered in all patients with unsuspected choledocholithiasis.