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cbd stone post cholecystectomy

Cbd stone post cholecystectomy

Per Videhult et al. [28] conducted a prospective, nonselected, population-based study and reported that the numbers of falsepositive and false-negative findings were relatively high and that fewer than half of the patients with elevated alkaline phosphatase or bilirubin were found to have CBD stone on IOC; alkaline phosphatase and bilirubin levels were the best predictors of CBD stones. In our institution, unenhanced CT is routinely performed postoperatively to detect retained CBD stones along with laboratory measurement of alkaline phosphatase and bilirubin concentrations. Irrespective of whether symptoms are persistent, the combination of unenhanced CT and alkaline phosphatase tests could offer a reliable, technically simple, and economical postoperative screening strategy to detect potential retained CBD stones following laparoscopic cholecystectomy for symptomatic cholelithiasis.

Peng et al. [3] reported that the overall incidence of CBD stones with GB stones was 11%–25%. It was comparable when considering sum of 184 patients of GB stones with concommitant CBD stones (184 of 2,111; 8.7%) and 20 patients who really had CBD stones after LC operation for symptomatic GB stones (20 of 1,467; 1.4%) could make up 10.1% in present study.

Continuous, normally distributed variables are presented as the median and range, while categorical variables are presented as the number (percent). All analyses were performed using PASW software ver. 18.0 (SPSS, Chicago, IL, USA).

Values are presented as number (%) or median (range).

Table 2

The prevalence of clinically significant retained CBD stone after LC for symptomatic cholelithiasis was 1.84% and the time from LC to clinical presentation ranged from 2 months to 2 years 9 months. Therefore, biliary surgeons should inform patients that retained CBD stone may be detected several years after LC for simple gallbladder stones.

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Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

In summary, the prevalence of clinically significant retained CBD stone after laparoscopic cholecystectomy in this study was 1.84%. The median time from laparoscopic cholecystectomy to ERCP was 152 days, ranging from postoperative 2 months to 2 years 9 months. Based on these findings, we recommend that biliary surgeons should notify their patients in advance of the risk of retained CBD stone, though low incidence, after laparoscopic cholecystectomy for symptomatic cholelithiasis and its necessity of following invasive treatment.

Patient demographics and clinical features of the initial operation

ERCP, endoscopic retrograde cholangiopancreatography; ERBD, endoscopic retrograde biliary drainage.

Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

All patients 18 years old or over, treated between 1 January 1998 and 31 December 2012, having undergone an ERCP with or without ES, were included. Cholecystectomy performed previously or within the first 2 months following ES was a requirement for inclusion.

Plot showing the time to recurrence for patients during the follow up period


The management options of CBDS without cholangitis can be operative, endoscopic or radiological. Operative approaches include open (trans-cystic or choledochotomy), laparoscopic (trans-cystic or choledochotomy) or endoscopic (ERCP), which was first described in 1974 [1]. Percutaneous trans hepatic decompression, is a radiological approach that is utilized less frequently and carries significant risk.


A total of 1148 patients underwent ERCP, of which 573 had an ES. Fifty-one patients underwent an ES prior to developing primary CBDS (8.9%). The time to recurrence ranged from 6 months to 15 years (mean 3.3 years). The number of procedures per patient ranged from 2 to 11, with 51% requiring 3 or more ERCPs. Factors associated with primary CBDS recurrence included a dilated CBD > 12 mm, stricture of the major papilla post ES to 2 – 5 mm and presence of the ampulla within or on the edge of a duodenal diverticulum.

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