Surgical strategy for recurrent common bile duct stones: a 10-year experience of a single center
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ORIGINAL ARTICLE
Surgical strategy for recurrent common bile duct stones: a 10‑year experience of a single center HongTian Xia1 · XianLei Xin1 · Tao Yang1 · Yang Liu1 · Bin Liang1 · Jing Wang1 Received: 14 April 2020 / Accepted: 3 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract Recurrence of common bile duct stones (CBDS) is common after surgical stone extraction, but the causes of recurrence are not fully understood. This study aimed to report the experience of treating recurrent CBDS. A total of 106 consecutive cases of recurrent CBDS treated from January 2006 to December 2015 were included. During surgery, the choledochoscopic passthrough test was performed to assess the structure and function of the duodenal papilla. The choledochoscopic pass-through test revealed 62 patients (58.49%) with incomplete closure of the lower end of the common bile duct, and 28 (26.42%) with stenosis at the lower common bile duct. Intra-operative bile bacterial culture was positive in 98 (92.45%) patients. The rate of complete stone clearance was 99.1%. The total recurrence rate of CBDS was 3.13%. The long-term success rate of surgical treatment (excellent and good) reached 92.7% .Duodenal papilla (Oddi sphincter) dysfunction is the main cause of recurrent CBDS. Common bile duct exploration with stone extraction, hilar ductoplasty, and Roux-en-Y hepaticojejunostomy can effectively eliminate the recurrence of CBDS and reduce the incidence of post-hepaticojejunostomy complications. Thus, it is an optimal surgical procedure for recurrent CBDS. Keywords Common bile duct stones (CBDS) · Postoperative recurrence · Duodenal papilla (oddi sphincter) · Roux-en-Y hepaticojejunostomy
Introduction Common bile duct stones (CBDS) frequently occur in the biliary tract, and are present in 10–20% of patients with symptomatic gallstones [1, 2]. Symptomatic CBDS stones may have a variety of clinical manifestations, such as obstructive jaundice, cholangitis, biliary cirrhosis, or pancreatitis [3]. The current minimally invasive surgical approaches for CBDS include laparoscopic common bile duct exploration (LCBDE) with stone extraction [4], and endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy (ERCP/EST) with common bile duct exploration (CBDE) and stone extraction [5, 6]. Currently,
HongTian Xia and XianLei Xin: equal contributions to the study and the publication.
LCBDE with stone extraction is the preferred method of surgical management of CBDS [7]. Although the aforementioned two procedures produce good results in most patients with CBDS, the postoperative recurrence rate of CBDS is still high. Studies have shown that 4–24% of patients develop recurrent CBDS after the initial surgical stone extraction [8–10]. Some patients even have multiple recurrences after several common bile duct explorations with stone extractions, and management of these cases is challenging [11]. Furthermore, there are no clinical guideline recommendations for the surgical management of recurrent CBDS. At our center, we have been
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