Management of Choledocholithiasis: Should We Remove the Bile Duct?

Mymensingh Med J. 2022 Apr;31(2):564-568.

Abstract

Retrieval of stone by endoscopic papillotomy, laparoscopic choledochotomy or open choledochotomy is the treatment of choice for choledocholithiasis. Published literature shows that the recurrence rate is 4% to 24% with existing method of treatment. We have treated 8 patients who admitted with recurrent choledocholithiasis in the department of Hepato-Biliary-Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh in the period of January 2016 to December 2019. None had intrahepatic duct abnormality or stones. All patients underwent either ERCP stenting, open choledocholithotomy or both 16 to 84 months back. Management policy is designed and outcome is observed on these patients. There were 3 males and 5 females; age ranges 18 to 60 years. The common bile duct (CBD) diameter of all patient ranges from 15 to 24mm. The shape of CBD is different from normal variant; S shaped, saculated, grossly dilated with terminal narrowing. Considering the anatomical abnormality and recurrence of disease we have removed the abnormal part of common bile duct along with stones and the operation was completed by Roux-en-Y hepaticojejunostomy. All patients were completely symptom free for 6 to 48 months after surgery. Removal of abnormal part of common bile duct with reconstruction in the form of Roux-en-Y hepatico-jejunostomy may be considered for treating choledocholithiasis with abnormal CBD (abnormally dilated, abnormally shaped, angulated or sacculated) however, long-term follow up is required for final comment.

MeSH terms

  • Adolescent
  • Adult
  • Anastomosis, Surgical
  • Cholangiopancreatography, Endoscopic Retrograde
  • Choledocholithiasis* / diagnosis
  • Choledocholithiasis* / surgery
  • Common Bile Duct / surgery
  • Female
  • Humans
  • Laparoscopy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sphincterotomy, Endoscopic
  • Treatment Outcome
  • Young Adult