The role of ERCP in management of retained bile duct stones after laparoscopic cholecystectomy.
BACKGROUND
Retained bile duct stones after cholecystectomy are an established entity. To find out the incidence of retained common bile duct (CBD) stones after laparoscopic cholecystectomy (LC) in our hospital, we conducted a retrospective study of patients who presented with symptomatic retained stones in the biliary system after a LC.


METHODS
Between the period 1992-2000, 824 LCs were performed in our hospital. Twenty-five of these returned to the hospital with symptoms and signs suggestive of CBD stones.


RESULTS
Prior to LC, ultrasound scans of all the patients showed gall stones. Alanine transaminase (ALT) was raised in 15 patients. All of these patients underwent LC. On readmission, ALT was raised in 20 patients, bilirubin was raised in 9 patients, and alkaline phosphatase (ALK) was raised in 16 patients. Ultrasound showed common bile duct dilatations in 16 patients, with 6 of these dilated bile ducts having stones. All 25 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)--with successful removal of stones in 16 cases, failure in 5 cases, and no stones in 4 cases. A second ERCP was successful in removing stones in 4 of the 5 failed patients.


CONCLUSIONS
In our hospital, the incidence of symptomatic retained stones after a LC is about 2.5%. Ultrasound is poor in visualising common bile duct stones although it detects CBD dilatations in majority of cases (76%). ERCP is an effective technique for diagnosis and treatment of retained post-LC stones, with minimum morbidity and no mortality in our small series.
Department of Surgery, Manchester Royal Infirmary, Manchester, UK. swinburn@deakin.edu.au
Suhail
S
Anwar
Romana
R
Rahim
Anselm
A
Agwunobi
John
J
Bancewicz
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000175:diagnosis* / Q000601:surgery; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D014463:Ultrasonography
D000410:Alanine Transaminase