From the Guidelines
Yes, you can develop choledocholithiasis after cholecystectomy, and the risk of complications from common bile duct stones (CBDS) is significant, with 25.3% of patients experiencing an unfavorable outcome if left untreated, as reported in a study published in Gut in 2017 1.
Background
Choledocholithiasis, or bile duct stones, can occur after cholecystectomy, a surgical procedure to remove the gallbladder. The natural history of common bile duct stones (CBDS) is not well understood, but complications can be life-threatening, including pain, biliary obstruction, cholangitis, hepatic abscesses, pancreatitis, and secondary biliary cirrhosis.
Risk of Complications
A study published in Gut in 2017 found that 25.3% of patients with CBDS left in situ experienced an unfavorable outcome, compared to 12.7% of patients who underwent stone extraction 1. This suggests that active treatment of CBDS can reduce the risk of complications.
Diagnosis and Treatment
Diagnosis of choledocholithiasis typically involves blood tests, ultrasound, magnetic resonance cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP). Treatment usually consists of ERCP with sphincterotomy and stone extraction. In some cases, medications like ursodeoxycholic acid may be prescribed to dissolve small stones.
Prevention
While there is no sure way to prevent choledocholithiasis after cholecystectomy, patients who have had their gallbladder removed should be aware of the potential symptoms and seek medical attention if they develop. A study published in the World Journal of Emergency Surgery in 2022 found that spilled gallstones during laparoscopic cholecystectomy can lead to complications, including choledocholithiasis, and that the incidence rate of complications from spilled gallstones may range from 0.04 to 19% 1.
Key Points
- Choledocholithiasis can occur after cholecystectomy
- The risk of complications from CBDS is significant, with 25.3% of patients experiencing an unfavorable outcome if left untreated
- Active treatment of CBDS can reduce the risk of complications
- Patients who have had their gallbladder removed should be aware of the potential symptoms and seek medical attention if they develop
- Spilled gallstones during laparoscopic cholecystectomy can lead to complications, including choledocholithiasis.
From the Research
Development of Choledocholithiasis after Cholecystectomy
- Choledocholithiasis can develop in patients after cholecystectomy, as evidenced by the fact that 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones 2.
- The literature suggests that choledocholithiasis may occur due to various reasons, including retained or primary CBD stones, choledochal cyst or stenosis, Oddi stenosis, duodenal para-Vater diverticulum, and anomaly biliary tree 3.
- In some cases, choledocholithiasis may be caused by the migration of surgical clips applied during laparoscopic cholecystectomy, which can lead to stagnation of bile flow and stone formation 4.
- The development of choledocholithiasis after cholecystectomy can be influenced by factors such as incomplete cholecystectomy, bile leakage, and the presence of congenital abnormalities of the biliary tract 3.
Diagnosis and Management
- Various modalities are available for assessing patients for choledocholithiasis, including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP) 2.
- Intraoperative cholangiography during cholecystectomy can be used to diagnose CBD stones, and endoscopic retrograde cholangiopancreatography (ERCP) is a common intervention for CBD stones 2, 5.
- Other management options for choledocholithiasis after cholecystectomy include intraoperative bile duct exploration, laparoscopic or open surgery, and percutaneous transhepatic stone removal 2, 6.
- The choice of management strategy depends on the clinical situation, the availability of equipment and skilled practitioners, and the patient's individual needs 2, 6.