[Recurrent and residual choledocholithiasis]

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Diagnostic Imaging

Background:

• Choledocholithiasis (ChDL) is a common complication following cholecystectomy.
• Residual and recurrent bile duct stones pose significant challenges in postcholecystectomy syndrome.
• Accurate diagnosis and effective management are crucial for patient outcomes.

Purpose of the Study:

• To analyze the causes of residual and recurrent choledocholithiasis in postcholecystectomy patients.
• To evaluate the diagnostic value of clinical symptoms and ultrasound (US) in detecting ChDL.
• To provide recommendations for prophylaxis and management of residual ChDL.

Main Methods:

• Retrospective analysis of 617 patients treated for choledocholithiasis.
• Review of clinical symptoms, diagnostic imaging (US), and intraoperative findings.
• Assessment of treatment outcomes, including surgical interventions and non-surgical management.

Main Results:

• High rates of residual (72.4%) and recurrent (21.4%) lithiasis were observed.
• Incomplete stone removal occurred in 78.5% of patients undergoing choledochotomy with cholecystectomy.
• Choledocholithiasis without jaundice was detected in 47.4% of patients.
• Ultrasound demonstrated significant diagnostic value in identifying ChDL.

Conclusions:

• Incomplete stone removal is a major cause of residual choledocholithiasis.
• Early and accurate diagnosis using clinical and US findings is essential.
• T-tube drainage after choledochotomy and non-surgical elimination of residual stones are recommended strategies.