Curative surgical treatment of common bile duct stones: Retrospective cohort study

BACKGROUND

In the event of symptomatic common bile duct (CBD) stones with dilated CBD, one possible curative treatment option is stone extraction through choledocotomy associated with cholecystectomy. Endoscopic treatment is only reserved for residual stones at 6 weeks. The aim of this study was to evaluate the results from laparoscopic curative surgical treatment of CBD stones with dilated CBD.

METHODS

This is a retrospective single-centered cohort study. All consecutive patients admitted for laparoscopic cholecystectomy with evidence of CBD stones with dilated CBD from January 2010 to December 2020 at our center were included. Success was defined by CBD clearance at 6 weeks. Need for additional procedures, such as endoscopic sphincterotomy, immediate, and end-of-procedure morbi-mortality as well as factors associated with procedure failure, were also studied.

RESULTS

A total of 246 patients who received curative treatment were included in the study. The success rate for the curative treatment was 93.1% (229 patients). Immediate postoperative morbidity was 24.4% with a 5.3% reintervention rate. Immediate and 6-week postoperative mortality rates were zero and 0.4%, respectively. The mean length of stay was 11.3 days. Factors associated with procedure failure appeared to be the occurrence of an early postoperative complication and the need for readmission during the period between surgery and drain removal.

CONCLUSION

This study indicates that laparoscopic curative surgical treatment for symptomatic CBD stones may be performed with acceptable results without routine need for additional procedures.

[Dormia catheter trapped in the bile duct: an unknown complication]

Conventional treatment of lithiasis of the main biliary tract (MBT) is based on endoscopic sphincterotomy followed by extraction of the stone(s) using a balloon catheter and/or Dormia catheter. Several risk factors associated with failure to remove a stone in the main biliary tract have been reported. The most important factor is probably a stone volume greater than 15 mm or an initial diameter of the MBT smaller than that of the stone. Care must be taken not to impact the stone in the Oddi sphincter or in the Dormia in order not to compromise stone removal. Complications associated with the use of the Dormia catheter include bile duct injuries, which are a well-known surgical problem. Injuries specifically related to the use of catheter have been less reported and seem to be underestimated. We here display an image showing Dormia catheter trapped in the bile duct around a fixed stone which couldn´t be removed after endoscopic exploration in a 60-year-old patient with cholangitis caused by lithiasis. Choledochotomy for removal of stone was performed.