Management of bile duct calculi : a study with special reference to long-term outcome

Open surgical versus endoscopic treatment of CBD stones in 80 elderly not cholecystectomized patients revealed a similar efficacy of stone clearance and early major complication rates, as well as total complication rates and hospitalization time in the two groups during 5 to 9 years follow-up. However, more patients in the endoscopically treated group died from heart disease, suggesting surgery to become the favoured treatment in this selected category of patients. Surgery was required in about 20 % and biliary related mortality was 3.3 % in 184 not cholecystectomized patients undergoing EST for CBD stones and followed for in average 6 years. Cholecystectomy was required more often in patients with an open cystic duct at cholangiography as compared to those with a blocked duct. The incidence of biliary problems after EST for CBD stones in 135 patients with remote cholecystectomy was a low 3.7 % during a mean follow-up of 7 years. Stone size over 10 mm or the complication of basket implication, were the only two factors found associated with a decreased bile duct clearance rate in 246 patients with CBD stones and the gallbladder in situ. No such risk factors were identified in 147 previously cholecystectomized patients. Routine preoperative infusion cholangiography (PIC) at elective cholecystectomy in 694 consecutive patients was not found to be warranted for identification of bile duct anomalies and a safe surgical procedure. PIC would need the support of peroperative cholangiography in about 20 % of patients in case of unsatisfactory opacification of the bile ducts (10 %) or unclear findings (10 %) at the PIC.