Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study.
BACKGROUND
Common bile duct (CBD) stones may be over looked at the time of laparoscopic cholecystectomy (LC), particularly when intra-operative cholangiography (IOC) is not performed. Currently, there is no data available about the time course and pattern of presentation for stones retained in the CBD at the time of LC. The aim of this study was to establish the time course and pattern of presentation of unsuspected retained CBD stones post LC.


METHODS
Patients presenting with symptomatic CBD stones from 1994 until 2010, having previously undergone LC were studied in this retrospective, case note review. CBD stones were confirmed at ERCP. Data collected included LC date, mode of presentation, imaging results including CBD diameter, stone appearance, length of stay and post ERCP complications. Patients having an ERCP for stones found on IOC at LC were excluded.


RESULTS
Sixty-one patients met the inclusion criteria. The most common mode of presentation was abdominal pain (n = 38, 62%) with (17) or without (21) deranged liver function tests. Nineteen (31%) patients presented with clinical complications of the CBD stones: cholangitis (10), acute biliary pancreatitis (6) or obstructive jaundice (3). The CBD was usually mild-to-moderately dilated (8-15 mm) on ultrasound. The median time span from LC to presentation with CBD stones was 4 years (range: 6 days-18 years). Five (8.2%) patients had a complication from their ERCP; mild pancreatitis (3), bleed (1) and cholangitis (1). Nineteen (31.1%) patients required more than one ERCP to complete stone/stent removal.


CONCLUSIONS
The median time for patients to present with symptomatic CBD stones after LC is 4 years. Patients with retrained stones may remain asymptomatic for many years. A third of the patients presented with potentially serious complications of the retained CBD stone. Future studies for CBD stones after LC need to follow patients for at least 10 years.
The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, New South Wales, 2751, Australia.
Michael R
MR
Cox
Joel P O
JP
Budge
Guy D
GD
Eslick
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000150:complications / Q000453:epidemiology*; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult