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?

Affiliations
  • 1Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
  • 2Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
  • 3Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Internal Medicine, Gachon Gil Hospital, Gachon University College of Medicine, Incheon, Korea
  • 5Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
  • 6Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
  • 7Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

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
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