Management of intraoperatively identified small bile duct stones in patients undergoing cholecystectomy

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Bunting, D.
Adesuyi, A.
Findlay, J.
Pawlak, M.
Sanders, D.
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Humans , *Gallstones/diagnostic imaging/surgery , Cholecystectomy , Bile Ducts , Cholangiopancreatography, Endoscopic Retrograde , Databases, Factual , Common bile duct calculi , Ultrasound
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INTRODUCTION: The management of CBDS (common bile duct stones) in patients with co-existing gallbladder stones has been debated. Guidelines recommend patients with CBDS identified on imaging should be offered duct clearance; however, this is based on low-quality evidence. This study aimed to investigate the natural history of small CBDS identified using IOUS (intraoperative ultrasound) in patients undergoing cholecystectomy. This may provide evidence to support a short-term expectant management approach in such patients. METHODS: Patients with CBDS diagnosed on IOUS during cholecystectomy were identified from a database of consecutive patients undergoing surgery. Patients with CBDS identified were divided into small stone (SS, =5 mm) and large stone (LS, >5 mm) groups. Intraoperative CBDS management, postoperative investigations, postoperative bile duct clearance, re-admissions, complications, length of stay (LOS) and follow-up are described. RESULTS: Fifty-nine of 427 patients had CBDS identified on IOUS. In the SS group (n=51), 46 patients underwent short-term expectant management rather than immediate/planned bile duct clearance. Following short-term expectant management, 41/46 patients (89.1%) did not require postoperative endoscopic retrograde cholangiopancreatography and at >3 year follow-up, none has since presented with residual CBDS. Median LOS was 0 days in the short-term expectant management group and 2 days in the immediate/planned bile duct clearance group, P=0.039. CONCLUSIONS: This study reports the natural history of small CBDS identified on IOUS in patients undergoing cholecystectomy. Such patients were safely treated with short-term expectant management associated with a reduced hospital LOS. This provides rationale for undertaking further research to establish this as a preferred management strategy.
Bunting D, Adesuyi A, Findlay J, Pawlak M, Sanders D. Management of intraoperatively identified small bile duct stones in patients undergoing cholecystectomy. Langenbeck's archives of surgery. 2024;409(1):70.
© 2024. The Author(s).
Langenbeck's archives of surgery
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