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Updated: Dec 24, 2025
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
The location of bile duct stones may affect intra- and postoperative cholecystectomy outcome: A population-based
Lars Enochsson1, Nicholas Sharp1, Karolina Gimberg1
1Department of Surgical and Perioperative Sciences, Surgery, Sunderby Research Unit, Umeå University, Umeå, Sweden.
Background:
Treatment for bile duct stones (BDS) depends largely on anatomical circumstances; yet, whether the outcome of cholecystectomies is impacted by the localization of intraoperatively discovered BDS remains largely unknown.
Methods:
A population-based registry study using data from the national Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks). 115,084 cholecystectomies 2006-2016 with the indications gallstone colic or complications were included. The surgical outcome between patients with distal BDS and those with at least one stone above the confluence was compared.
Results:
10,704 met the inclusion criteria. Patients with stones above the confluence had 16% longer operation times and significantly higher rates of intraoperative complications (OR 1.47), gut perforation (OR 4.60), and cholangitis (OR 1.96) compared to patients with distal BDS. The highest clearance rate (96%), as reflected by the need for re-ERCP, was seen after intraoperative ERCP, regardless of the localization of the BDS.
Conclusions:
Stones located above the confluence are associated with increased complication risks. These findings stress the importance of carefully considering the optimal methods for BDS removal during surgery.
