Ann Surg Treat Res.  2020 Dec;99(6):329-336. 10.4174/astr.2020.99.6.329.

What is the better surgical treatment option for recurrent common bile duct stones?

• Park CY
• Choi SH
• Kwon CI
• Cho JH
• Jang SI
• Lee TH
• Han JH
• Jeong S
• Ko KH

• KMID: 2508932
• DOI: http://doi.org/10.4174/astr.2020.99.6.329

Abstract

Purpose
Repeating endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent common bile duct (CBD) stones is problematic in many ways. Choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) are 2 surgical treatment options for recurrent CBD stones, and each has different advantages and disadvantages. The aim of this study was to compare the 2 surgical options in terms of the recurrence rate of CBD stones after surgical treatment.
Methods
This retrospective multicenter study included all patients who underwent surgical treatment due to recurrent CBD stones that were not effectively controlled by medical treatment and repeated ERCP between January 2006 and March 2015. We collected data from chart reviews and medical records. A recurrent CBD stone was defined as a stone found 6 months after the complete removal of a CBD stone by ERCP. Patients who underwent surgery for other reasons were excluded.
Results
A total of 27 patients were enrolled in this study. Six patients underwent CDS, and 21 patients underwent CJS for the rescue treatment of recurrent CBD stones. The median follow-up duration was 290 (180–1,975) days in the CDS group and 1,474 (180–6,560) days in the CJS group (P = 0.065). The postoperative complications were similar and tolerable in both groups (intestinal obstruction; 2 of 27, 7.4%; 1 in each group). CBD stones recurred in 4 patients after CDS (4 of 6, 66.7%), and 3 patients after CJS (3 of 21, 14.3%) (P = 0.010).
Conclusion
CJS may be a better surgical option than CDS for preventing further stone recurrence in patients with recurrent CBD stones.

Keyword

Choledochoduodenostomy; Choledochojejunostomy; Choledocholithiasis; Choledochostomy; Endoscopic retrograde cholangiopancreatography

Figure

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  Fig. 1 (A) CT findings at the first visit. Heterogeneous material fills in the dilated common bile duct (CBD). (B) Cholangiography findings by endoscopic retrograde cholangiopancreatography at the first visit. Numerous and various sized round filling defects in the dilated CBD. (C) Findings from a cholangiography performed through a nasobiliary drainage tube at the third recurrence. Unlike the first attack, larger filling defects are impacted within the dilated CBD. (D) Cholangiography findings at the first recurrence of CBD stones after choledochoduodenostomy (CDS). As with previous recurrence findings, large filling defects are impacted within the dilated CBD. (E) Endoscopic findings at the third recurrence of CBD stones after CDS. Whitish pus is drained from the CDS site. (F) The last CT findings at 48 months after choledochojejunostomy (CJS). Stone recurrence is not observed in the remaining proximal CBD and CJS areas.

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