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Background <p>Recurrent common bile duct stone (CBDS) following laparoscopic bile duct exploration (LCBDE) represents a clinically significant long-term complication, with implications for patient morbidity, healthcare utilization, and procedural outcomes. This study aims to quantify the incidence of recurrent CBDS and identify potentially modifiable risk factors in a high-volume referral center </p> Methods <p>A 30-year prospectively maintained database of LCBDE was analyzed. Recurrences were defined by clinical and biochemical suspicion, with or without radiological confirmation, and included non-intervention cases. Electronic records were reviewed in 2020 and 2023 to identify additional episodes not captured in the original database.</p> Results <p>Among 1447 patients undergoing LCBDE, 56 (3.8%) developed recurrent choledocholithiasis after a median interval of 24&#xa0;months (range: 5–220). Twelve patients (21.4%) experienced spontaneous resolution, while 44 patients (78.6%) had 61 confirmed recurrence episodes. Eight resolved with conservative management, while 53 episodes required 65 ERCPs. Multiple recurrences occurred in 13 patients (23.2%).</p> <p>Patients with recurrence were significantly older (median age 72 vs 60&#xa0;years, <i>p</i> &lt; 0.001), had larger stones (median diameter 10&#xa0;mm vs 8&#xa0;mm, <i>p</i> &lt; 0.001), were more likely to have had a difficult LCBDE (64.3% vs 27.8%, <i>p</i> &lt; 0.001), via a&#xa0;choledochotomy (55.4% vs 30.5%, <i>p</i> &lt; 0.001), or required&#xa0;T-tube drainage (37.7% vs 15.1%, <i>p</i> &lt; 0.001).</p> Conclusions <p>Recurrent CBDS occurred in 3.8% of patients who underwent LCBDE (3% confirmed), a rate notably lower than the 4–30% reported after sphincterotomy. Glucagon may aid the spontaneous passage of small stones in suspected recurrence episodes. Multiple recurrences affected 23.2% of patients, warranting consideration of bile acid dissolution therapy. Two modifiable factors significantly reduce recurrence risk: avoiding preoperative sphincterotomy and favoring transcystic over choledochotomy exploration.</p>

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Recurrent choledocholithiasis after laparoscopic bile duct exploration: incidence, risk factors, and management strategies

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Ahmad H. M. Nassar,
  • Hisham I. Elzanati,
  • Khurram S. Khan,
  • Israa H. Hayyawi,
  • Ahmad M. Yehia,
  • Asmaa H. Omran

摘要

Background

Recurrent common bile duct stone (CBDS) following laparoscopic bile duct exploration (LCBDE) represents a clinically significant long-term complication, with implications for patient morbidity, healthcare utilization, and procedural outcomes. This study aims to quantify the incidence of recurrent CBDS and identify potentially modifiable risk factors in a high-volume referral center

Methods

A 30-year prospectively maintained database of LCBDE was analyzed. Recurrences were defined by clinical and biochemical suspicion, with or without radiological confirmation, and included non-intervention cases. Electronic records were reviewed in 2020 and 2023 to identify additional episodes not captured in the original database.

Results

Among 1447 patients undergoing LCBDE, 56 (3.8%) developed recurrent choledocholithiasis after a median interval of 24 months (range: 5–220). Twelve patients (21.4%) experienced spontaneous resolution, while 44 patients (78.6%) had 61 confirmed recurrence episodes. Eight resolved with conservative management, while 53 episodes required 65 ERCPs. Multiple recurrences occurred in 13 patients (23.2%).

Patients with recurrence were significantly older (median age 72 vs 60 years, p < 0.001), had larger stones (median diameter 10 mm vs 8 mm, p < 0.001), were more likely to have had a difficult LCBDE (64.3% vs 27.8%, p < 0.001), via a choledochotomy (55.4% vs 30.5%, p < 0.001), or required T-tube drainage (37.7% vs 15.1%, p < 0.001).

Conclusions

Recurrent CBDS occurred in 3.8% of patients who underwent LCBDE (3% confirmed), a rate notably lower than the 4–30% reported after sphincterotomy. Glucagon may aid the spontaneous passage of small stones in suspected recurrence episodes. Multiple recurrences affected 23.2% of patients, warranting consideration of bile acid dissolution therapy. Two modifiable factors significantly reduce recurrence risk: avoiding preoperative sphincterotomy and favoring transcystic over choledochotomy exploration.