ArticleSurgical endoscopy2026
Recurrent choledocholithiasis after laparoscopic bile duct exploration: incidence, risk factors, and management strategies.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRecurrent 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
methodsA 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.
resultsAmong 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).
conclusionsRecurrent 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.
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