Abstract
Introduction. In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series. Methods. One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required. Results. Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy. Conclusions. Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique.
Highlights
In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC)
After the introduction of LC, the diagnosis and management of common bile ductal stones (CBDS) have largely relied on preoperative detection and clearance by endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected CBDS based on clinical indicators
Specific symptoms of bile stasis occurred in one (2.1%) female patient presenting with episodes of cholangitis that occurred sixteen years after LC + LC and common bile duct exploration (LCBDE)
Summary
In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). After the introduction of LC, the diagnosis and management of CBDS have largely relied on preoperative detection and clearance by endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected CBDS based on clinical indicators (history, laboratory exams, and ultrasound). This is associated with between 20% and 60% of negative and useless endoscopic procedures, due to the low predictive value of the clinical indicators of ductal stones [4]. The introduction of less invasive imaging techniques, such as magnetic resonance cholangiography (CMRI) [9] and endoscopic ultrasound (EUS) [10], eliminates the need for a purely diagnostic ERCP but they increase the diagnostic burden for the patient and increase costs
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