title: Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factor analysis.
abstract: OBJECTIVE
  Incidence of common bile duct stones (CBDS) is approximately 10% in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy. Transcystic laparoscopic common bile duct exploration (TC-CBDE) is safe and efficient in achieving bile duct clearance from stones, with a success rate of between 85% and 95%. The aim of this retrospective study is the evaluation of risk factors and recurrence in patients treated with TC-CBDS.
  
  
  METHODS
  From October 2003 until September 2007, 110 consecutive patients with common bile duct stones and gallbladder were included in the study. Average age was 64 years (range 21-82 years). The procedure was completed laparoscopically in 106 patients (96.4%): with TC-CBDE in 90 patients (85%), who are the object of this study; and with TC-CBDE + perioperative guide wire papillotomy ("rendezvous") in 16 cases (15%). In the 90 patients treated with TC-CBDE which we examined, the risk factors were: preoperative liver function tests, diameter of the common bile duct (normal 8 mm or less), number of stones (<or=3 or more), presence of stones with biliary sludge, and pre- or intraoperative diagnosis. Student's test was used for statistical analysis with a P value of < 0.05 defined as statistically significant.
  
  
  RESULTS
  The conversion rate to open surgery was 3.6%. There were no mortalities. The average operative time was 115.6 min. The morbility rate was 7.7% with 4.8% local complications and 2.9% general complications. Average follow-up on 90 patients (after TC-CBDE) was 28 months (range 4.2-48 months). We found six recurrences (6.7%). The statistic analysis showed that only number of stones >3 with biliary sludge predicted a recurrence (p < 0.05) while the other factors did not show important clinical variables.
  
  
  CONCLUSIONS
  TC-CBDE is safe and effective in the majority of cases of CBDS. The incidence of recurrence is low but there are some risk factors, such as number of stones >3 with biliary sludge, which do not favor the successful outcome of the procedure. In such cases, it is essential that the TC-CBDE is integrated with other procedures which, although more complex, assure the clearance of the bile duct.
authors.affiliation: Department of Surgery, University G D'Annunzio, Palazzina SEBI, Chieti, Italy. above@unich.it
authors.forename: A
authors.initials: A
authors.lastname: Bove
authors.forename: G
authors.initials: G
authors.lastname: Bongarzoni
authors.forename: G
authors.initials: G
authors.lastname: Palone
authors.forename: R M
authors.initials: RM
authors.lastname: Di Renzo
authors.forename: E M
authors.initials: EM
authors.lastname: Calisesi
authors.forename: L
authors.initials: L
authors.lastname: Corradetti
authors.forename: M
authors.initials: M
authors.lastname: Di Nicola
authors.forename: L
authors.initials: L
authors.lastname: Corbellini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000150:complications; D042883:Choledocholithiasis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007813:Laparotomy / Q000706:statistics & numerical data; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D015641:Radiography, Interventional / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult