Skip to main content
NCBI home page
The Ulster Medical Journal logoLink to The Ulster Medical Journal
. 2005 Sep;74(2):108–112.

Natural history of asymptomatic bile duct stones at time of cholecystectomy.

G R Caddy 1, J Kirby 1, S J Kirk 1, M J Allen 1, R J Moorehead 1, T C Tham 1
PMCID: PMC2475382  PMID: 16235763

Abstract

OBJECTIVES: There is little data on the natural history of asymptomatic bile duct stones and hence there is uncertainty on the management of asymptomatic bile duct stones discovered incidentally at the time of laparoscopic cholecystectomy. We retrospectively reviewed a group of patients who had previously underwent laparoscopic cholecystectomy, but who did not have a pre-operative suspicion of intra-ductal stones, to determine if any biliary complications had subsequently developed. A group of patients who had no pre-operative suspicion of intra-ductal stones, but routinely underwent intraoperative cholangiogram (IOC) at time of cholecystectomy, served as the control group. METHODS: A telephone questionnaire was completed by each patient's family practitioner in 59 of 79 (75%) patients who underwent laparoscopic cholecystectomy. In the remaining 20 patients additional information was obtained from hospital records and from the central services agency (CSA). These patients had no pre-operative suspicion of bile duct stones and therefore did not undergo an IOC or ERCP. The control group (73 patients) had no pre-operative suspicion of bile duct stones but had a routine IOC performed to define the biliary anatomy. RESULTS: 59 patients were followed up for an average of 57 months (range 30-78 months) after laparoscopic cholecystectomy. None of these patients developed pancreatitis, jaundice, deranged liver function tests (LFT's), or required ERCP or other biliary intervention. In the additional 20 patients where no information was available from the family practitioner, 11 patients had follow up appointments with no documentation of biliary complications or abnormal LFT's. 19 of 20 patients were traceable through the CSA and were all alive. Only 1 patient was untraceable and therefore unknown if biliary complications had developed. In the control group, 4 of 73 (6%) patients had intraductal stones detected and extracted. Thus the prevalence of asymptomatic bile duct stones during the time of cholecystectomy in our population was 6%. CONCLUSIONS: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed.

Full text

PDF
108

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta M. J., Rossi R., Ledesma C. L. The usefulness of stool screening for diagnosing cholelithiasis in acute pancreatitis. A description of the technique. Am J Dig Dis. 1977 Feb;22(2):168–172. doi: 10.1007/BF01072962. [DOI] [PubMed] [Google Scholar]
  2. Barkun A. N., Barkun J. S., Fried G. M., Ghitulescu G., Steinmetz O., Pham C., Meakins J. L., Goresky C. A. Useful predictors of bile duct stones in patients undergoing laparoscopic cholecystectomy. McGill Gallstone Treatment Group. Ann Surg. 1994 Jul;220(1):32–39. doi: 10.1097/00000658-199407000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Esber E. J., Sherman S. The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Gastrointest Endosc Clin N Am. 1996 Jan;6(1):57–80. [PubMed] [Google Scholar]
  4. Frossard J. L., Hadengue A., Amouyal G., Choury A., Marty O., Giostra E., Sivignon F., Sosa L., Amouyal P. Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc. 2000 Feb;51(2):175–179. doi: 10.1016/s0016-5107(00)70414-7. [DOI] [PubMed] [Google Scholar]
  5. Hauer-Jensen M., Karesen R., Nygaard K., Solheim K., Amlie E. J., Havig O., Rosseland A. R. Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: long-term follow-up and multivariate analysis of predictors of choledocholithiasis. Surgery. 1993 Mar;113(3):318–323. [PubMed] [Google Scholar]
  6. Ijzermans J. N., De Waard P., Merkelbach J. W. Cholangiography during cholecystectomy: a plea for selective use. Neth J Surg. 1989 Aug;41(4):79–81. [PubMed] [Google Scholar]
  7. Johnson A. G., Hosking S. W. Appraisal of the management of bile duct stones. Br J Surg. 1987 Jul;74(7):555–560. doi: 10.1002/bjs.1800740703. [DOI] [PubMed] [Google Scholar]
  8. Murison M. S., Gartell P. C., McGinn F. P. Does selective peroperative cholangiography result in missed common bile duct stones? J R Coll Surg Edinb. 1993 Aug;38(4):220–224. [PubMed] [Google Scholar]
  9. O'Donovan A. N., O'Sullivan G., Ireland A., FitzGerald E. Prospective trial of the role of fine bore intubation of the cystic duct at the time of operative cholangiography. J Am Coll Surg. 1997 Mar;184(3):262–264. [PubMed] [Google Scholar]
  10. Onken J. E., Brazer S. R., Eisen G. M., Williams D. M., Bouras E. P., DeLong E. R., Long T. T., 3rd, Pancotto F. S., Rhodes D. L., Cotton P. B. Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol. 1996 Apr;91(4):762–767. [PubMed] [Google Scholar]
  11. Rijna H., Borgstein P. J., Meuwissen S. G., de Brauw L. M., Wildenborg N. P., Cuesta M. A. Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery. Br J Surg. 1995 Aug;82(8):1130–1133. doi: 10.1002/bjs.1800820840. [DOI] [PubMed] [Google Scholar]
  12. Rosseland A. R., Glomsaker T. B. Asymptomatic common bile duct stones. Eur J Gastroenterol Hepatol. 2000 Nov;12(11):1171–1173. doi: 10.1097/00042737-200012110-00001. [DOI] [PubMed] [Google Scholar]
  13. Roston A. D., Jacobson I. M. Evaluation of the pattern of liver tests and yield of cholangiography in symptomatic choledocholithiasis: a prospective study. Gastrointest Endosc. 1997 May;45(5):394–399. doi: 10.1016/s0016-5107(97)70150-0. [DOI] [PubMed] [Google Scholar]
  14. Sahai A. V., Mauldin P. D., Marsi V., Hawes R. H., Hoffman B. J. Bile duct stones and laparoscopic cholecystectomy: a decision analysis to assess the roles of intraoperative cholangiography, EUS, and ERCP. Gastrointest Endosc. 1999 Mar;49(3 Pt 1):334–343. doi: 10.1016/s0016-5107(99)70010-6. [DOI] [PubMed] [Google Scholar]
  15. Sarli L., Costi R., Gobbi S., Sansebastiano G., Roncoroni L. Asymptomatic bile duct stones: selection criteria for intravenous cholangiography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Eur J Gastroenterol Hepatol. 2000 Nov;12(11):1175–1180. [PubMed] [Google Scholar]
  16. Sarli L., Pietra N., Franzé A., Colla G., Costi R., Gobbi S., Trivelli M. Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc. 1999 Aug;50(2):200–208. doi: 10.1016/s0016-5107(99)70225-7. [DOI] [PubMed] [Google Scholar]
  17. Thurston O. G., McDougall R. M. The effect of hepatic bile on retained common duct stones. Surg Gynecol Obstet. 1976 Oct;143(4):625–627. [PubMed] [Google Scholar]
  18. Trondsen E., Edwin B., Reiertsen O., Fagertun H., Rosseland A. R. Selection criteria for endoscopic retrograde cholangiopancreaticography (ERCP) in patients with gallstone disease. World J Surg. 1995 Nov-Dec;19(6):852–857. doi: 10.1007/BF00299784. [DOI] [PubMed] [Google Scholar]
  19. Wilson T. G., Jeans P. L., Anthony A., Cox M. R., Toouli J. Laparoscopic cholecystectomy and management of choledocholithiasis. Aust N Z J Surg. 1993 Jun;63(6):443–450. doi: 10.1111/j.1445-2197.1993.tb00424.x. [DOI] [PubMed] [Google Scholar]

Articles from The Ulster Medical Journal are provided here courtesy of Ulster Medical Society

RESOURCES