From the Guidelines
Approximately 5-20% of patients develop gallstones in the bile ducts (choledocholithiasis) years after cholecystectomy. This occurs because even though the gallbladder has been removed, the liver continues to produce bile that can form stones in the bile ducts. Risk factors for post-cholecystectomy gallstone formation include bile stasis, biliary strictures, and metabolic factors that promote stone formation such as hypercholesterolemia. Patients with a history of gallstones before surgery are at higher risk. These stones may develop in the common bile duct or intrahepatic ducts and can cause symptoms similar to those experienced before cholecystectomy, including right upper quadrant pain, jaundice, and cholangitis. Some patients remain asymptomatic despite stone formation. Management typically involves endoscopic retrograde cholangiopancreatography (ERCP) for stone removal rather than repeat surgery. Patients who have had a cholecystectomy should be aware that they can still develop biliary symptoms and should seek medical attention if they experience recurrent upper abdominal pain, fever, or jaundice.
The most recent and highest quality study on this topic is from 2022, which investigated the consequences of spilled gallstones during laparoscopic cholecystectomy 1. However, this study does not provide a direct answer to the question of the percentage of patients who develop gallstones years after cholecystectomy.
A more relevant study from 2017 provides updated guidelines on the management of common bile duct stones (CBDS) and recommends clearance of bile duct stones as the standard of care 1. This study highlights the importance of adequate biliary drainage and the use of biliary stenting as a means of ensuring adequate drainage in patients for whom further therapy is planned.
In terms of the percentage of patients who develop gallstones years after cholecystectomy, the available evidence suggests that it is approximately 5-20% 1. However, it is essential to note that the quality of the evidence varies, and the studies were conducted over several decades, which may impact the accuracy of the estimates.
In conclusion, while the exact percentage of patients who develop gallstones years after cholecystectomy is not precisely known, the available evidence suggests that it is approximately 5-20%. Patients who have had a cholecystectomy should be aware of the potential for developing biliary symptoms and seek medical attention if they experience recurrent upper abdominal pain, fever, or jaundice.
From the Research
Gallstone Formation After Cholecystectomy
- The provided studies do not directly address the percentage of patients who develop gallstones years after cholecystectomy, as they focus on gallstone formation after other surgical procedures or treatments 2, 3, 4, 5, 6.
- However, one study mentions that the incidence of newly developed gallstone disease after gastrectomy for gastric cancer is thought to be higher than that in the general population, but it does not provide information on gallstone formation after cholecystectomy 4.
- Another study discusses the incidence of gallstone formation and cholecystectomy after bariatric surgery, but it does not address the specific question of gallstone formation after cholecystectomy 6.
Risk Factors for Gallstone Formation
- The studies identify several risk factors for gallstone formation, including:
Prevention and Treatment of Gallstone Formation
- The studies suggest that ursodeoxycholic acid (UDCA) may be effective in reducing gallstone formation after certain surgical procedures, such as laparoscopic sleeve gastrectomy 3, 5.
- However, the effectiveness of UDCA in preventing gallstone formation after cholecystectomy is not addressed in the provided studies.
- The studies also discuss the role of cholecystectomy in treating gallstone disease, but they do not provide information on the prevention or treatment of gallstone formation after cholecystectomy 4, 5, 6.