Causes and surgical management of choledocholithiasis after cholecystectomy

Abstract Background The purpose of this study was to determine reasons for choledocholithiasis after cholecystectomy and the most effective treatment. Materials and Methods The records of patients with choledocholithiasis after cholecystectomy treated by the Department of Hepatobiliary Surgery (HS) or the Department of Gastroenterology (Gastro) at our hospital from 2007 to 2016 were retrospectively analyzed. Patients in the HS group received surgical exploration of common bile duct and lithotomy or exploration of the common bile duct, lithotomy, and cholangiojejunostomy. The Gastro group received exploration of common bile duct (endoscopic retrograde cholangiopancreatography) and lithotomy and endoscopic sphincterotomy. Complications and short- and long-term outcomes were compared. Results There were 86 patients in the HS group (mean age 43 ± 11 years) (56, exploration of the common bile duct and lithotomy; 30 exploration of the common bile duct, lithotomy, and biliary-enteric anastomosis) and 48 in the Gastro group (mean age 43 ± 13 years). In the HS group, 63% of patients had abnormal structure/dysfunction of the Oddis sphincter, and 91% had positive bile cultures. Exploration of the common bile duct, lithotomy and cholangiojejunostomy produced the highest excellent + good results rate (90%) and the lowest rate of recurrent choledocholithiasis (3%). Exploration of common bile duct and lithotomy (gastro group) was associated with the worst outcomes (excellent + good rate = 46%; recurrent choledocholithiasis = 46%). Conclusion Abnormal structure/dysfunction of the Oddis sphincter is the main cause of choledocholithiasis after cholecystectomy. Exploration of the common bile duct, lithotomy, and cholangiojejunostomy results in the best outcomes.