Recurrence of choledocholithiasis following laparoscopic common bile duct exploration: a multicenter study and recurrent common bile duct stones

Abstract

Introduction: According to updated guideline on the management of common bile duct stones(CBDS), In 10-20% of individuals with symptomatic gallstones, CBDS are estimated to be present. As well as after ERCP, recurrence of primary CBDS occurs after Laparoscopic common bile duct exploration (LCBDE). This study aimed to investigate risk factors for the recurrence of primary stones after LCBDE. Method: Patient who underwent LCBDE between January 2001 and December 2018 in 4 teaching hospitals in South,Korea were included. Patient, diagnostic, intra-operative and disease-related factors were collected from the patient charts. Specificically operation record, fluorocsopy and ERCP record were investigated, retrospectively. Primary outcome was recurrence. Multivariable logistic regression was performed to identifiy independent risk factors for CBDS recurrence. Result: 230 Patients were included. 31 Patients had recurrences. In univariable analysis CBD stone size (>9mm) (p=0.003), Multiple stone (≥2) (p=0.031), Stone size (≥1.5cm) (p=0.041), CBD diameter (≥12mm) (p=0.005) ,CBD dilatation (≥10mm) (p=0.02), Prior laparoscopic cholecystectomy history (p=0.002) were associated with Recurrence. After multivariable logistic regression, recurrences are associated CBD stone size (>9mm) (adjusted odds ratio [AOR] 4.28 ; 95% confidence interval [CI] 1.40-13.07 (p=0.011), CBD dilatation (≥10mm) [AOR] 5.85 ; 95% confidence interval [CI] 1.69-20.34 (p=0.005), Prior laparoscopic cholecystectomy history [AOR] 3.50 ; 95% confidence interval [CI] 1.31-9.35 (p=0.013). Conclusion: Stone size (more than 9mm), CBD dilatation (≥10mm), and prior cholecystectomy history are risk factors for CBDS recurrences and warrants close monitoring after operation.