Assessment of the possible risk factors for primary common bile duct stone recurrence after cholecystectomy
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and Other Interventional Techniques
Assessment of the possible risk factors for primary common bile duct stone recurrence after cholecystectomy Min Kyu Chae1 · Seung Hwan Lee2 · Kwang Ro Joo1 Received: 7 April 2020 / Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Common bile duct (CBD) stone recurrence is considered an unresolved concern after cholecystectomy and complete extraction of previous CBD stones. This study aimed to investigate the potential risk factors for primary CBD stone recurrence after cholecystectomy and endoscopic treatment. Methods The endoscopic retrograde cholangiopancreatography (ERCP) database of our medical center was retrospectively reviewed between February 2008 and May 2018. A total of 45 patients with CBD stone recurrence with a history of previous cholecystectomy were recruited in the study. Moreover, 104 patients who underwent cholecystectomy at our medical center and who were followed up for more than 1 year without CBD stone recurrence were assigned to the control group. The characteristics of the patients, surgical records during cholecystectomy, and ERCP records obtained immediately before cholecystectomy were analyzed. Results Univariate analysis, based on the binary logistic regression method, indicated that age (p = 0.01) and the presence of the periampullary diverticulum (PAD; p = 0.006) were significantly different between the non-recurrence and recurrence groups. However, the surgical records during cholecystectomy were not significantly different between the two groups. The CBD stone number (p = 0.039), CBD stone diameter (≥ 10 mm; p = 0.05), and CBD diameter (≥ 15 mm; p < 0.001), based on the ERCP findings were significantly different between the two groups. Multivariate analysis revealed that CBD diameter (≥ 15 mm; OR, 3.878; 95% CI, 1.406–10.697; p = 0.008) was the independent risk factors for CBD stone recurrence after cholecystectomy. Conclusions CBD diameter (≥ 15 mm) at the time of the initial ERCP is associated with CBD stone recurrence after cholecystectomy. Keywords Cholecystectomy · Common bile duct stone · Recurrence · Risk factor Cholecystectomy is recommended in patients with an intact gallbladder (GB) stone after endoscopic extraction of common bile duct (CBD) stones to prevent cholecystitis or CBD stone recurrence [1]. Moreover, a recent study has reported that the earlier the surgery is performed, the better are the clinical outcomes of cholecystectomy. Aziret et al. suggested that early laparoscopic cholecystectomy (LC) following * Kwang Ro Joo [email protected] 1
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
2
stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) was associated with a reduced risk of complications [2]. However, C
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