Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factors' analysis

Aim Incidence of common bile duct stones (CBDS) is approximately 10% in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy. Transcystic laparoscopic common bile duct exploration (TC-CBDE) is safe and efficient in achieving bile duct clearance from stones, with a success rate of between 85% and 95%. The aim of this retrospective study is the evaluation of risk factors and recurrence in patients treated with TC-CBDS. Methods From October 2003 until September 2007, 110 consecutive patients with common bile duct stones and gallbladder were included in the study. Average age was 64 years (range 21–82 years). The procedure was completed laparoscopically in 106 patients (96.4%): with TCCBDE in 90 patients (85%), who are the object of this study; and with TC-CBDE ? perioperative guide wire papillotomy (‘‘rendezvous’’) in 16 cases (15%). In the 90 patients treated with TC-CBDE which we examined, the risk factors were: preoperative liver function tests, diameter of the common bile duct (normal 8 mm or less), number of stones (B3 or more), presence of stones with biliary sludge, and pre- or intraoperative diagnosis. Student’s test was used for statistical analysis with a P value of\0.05 defined as statistically significant. Result The conversion rate to open surgery was 3.6%. There were no mortalities. The average operative time was 115.6 min. The morbility rate was 7.7% with 4.8% local complications and 2.9% general complications. Average follow-up on 90 patients (after TC-CBDE) was 28 months (range 4.2–48 months). We found six recurrences (6.7%). The statistic analysis showed that only number of stones [3 with biliary sludge predicted a recurrence (p\0.05) while the other factors did not show important clinical variables. Conclusion TC-CBDE is safe and effective in the majority of cases of CBDS. The incidence of recurrence is low but there are some risk factors, such as number of stones [3 with biliary sludge, which do not favor the successful outcome of the procedure. In such cases, it is essential that the TC-CBDE is integrated with other procedures which, although more complex, assure the clearance of the bile duct. Keywords Common bile stones Transcystic laparoscopic extraction Recurrence Risk factors