SUMMARY BACKGROUND DATA: Two-hundred thirteen outpatients who were treated for
choledocholithiasis from 1982 to 1996 were selected as subjects and monitored for a period ranging from 5 to 19 years (mean, 9.6 years). The 213 patients were divided into 3 groups: 87 patients who had undergone choledocholithotomy and T-tube drainage (including the use of the laparoscopic method), 44 patients who had undergone
choledochoduodenostomy, and 82 patients whose stones were removed by
endoscopic sphincterotomy (EST). Recurrence of
lithiasis was examined for each type of treatment modality.
RESULTS:
Choledochoduodenostomy was performed in 44 cases for the purpose of preventing any recurrence. The recurrent rate was analyzed in 169 cases.
Choledocholithiasis recurred in 17 of the 169 cases (10.1%). The remaining 152 patients that showed no recurrence of
lithiasis were examined and compared. The diameter of the common bile duct measured during the initial treatment was more dilated in patients with recurrent
lithiasis (16.6 +/- 5.9 mm) than in patients without any recurrence (9.8 +/- 4.9 mm; P < 0.05). Peripapillary
diverticula were observed in 10 of the 17 patients with recurrent
lithiasis (58.8%), and in 34 of the 152 nonrecurrent patients (22.3%), showing that
diverticula were more common in recurrent cases (P < 0.05). Furthermore, while primary bile duct stones were found in 11 of the 17 cases with recurrent
lithiasis (64.7%), primary stones were found in only 37 of the 152 nonrecurrent patients (24.3%), showing primary bile duct stones were also more common in recurrent patients (P < 0.05). The recurrent patients were examined by
surgical procedure. Nine patients with choledocholithotomy and T-tube drainage had a recurrence (10.3%), and 8 patients in the EST group had a recurrence (9.8%). The recurrence rates for these procedures were higher than for cases with
choledochoduodenostomy (recurrence rate: 0%, P < 0.05). In particular,
lithiasis recurred in 5 of the 12 patients with T-tube drainage for primary bile duct stones (41.7%).
CONCLUSION: Although choledocholithotomy and T-tube drainage, including open and laparoscopic surgery, is presently a common procedure for
choledocholithiasis, this procedure will not necessarily prevent a recurrence of the disease. For older patients with primary bile duct stones,
choledochoduodenostomy or EST is recommended.