THE NEED FOR LAPAROSCOPIC CHOLECYSTECTOMY IN THE PATIENT WITHOUT GB STONE AFTER CBD STONE CLEARANCE

Aims Cholecystectomy after endoscopic removal of the common bile duct stones is generally recommended to prevent recurrence of biliary complications. The rate of following these recommendation is low. The aim of this study was to evaluate the need for laparoscopic cholecystectomy in the patient without GB stone after CBD stone clearance.

Methods From January 2009 to December 2018, we retrospectively analyzed 2150 patients with EST and CBD stone removal at Keimyung University Hospital. We excluded 808 patients who were followed for less than 3 months. 1342 patients were enrolled in this study. We divided the patient into four groups according to GB status. 342 patients had previously undergone cholecystectomy (Group A), 465 had a calculous GB and underwent cholecystectomy after EST (Group B), 243 had a calculous GB in situ (Group C), and 292 had an acalculous GB in situ (Group D). Long term complications, including recurrence of CBD and cholecystitis were evaluated.

Results During the median follow up of 37 months (range 3-128months) total biliary complication occurred in 250 patients (25%). The rate of CBD stone recurrence rate was higher in Group C (23.0%) than in Group B(16.8%) (p=0.043). Cumulative total biliary complication rate was higher in Group C (46.1%) than Group D (20.5%) (p< 0.001). Cholecystitis occurred more frequently in Group C (22.9%) than in Group D (2.4%) (p< 0.001). There was no significant difference in the rate of recurrent CBD stone between Group B (16.8%) and Group D (18.2%) (p=0.626) and rate of total biliary complication between Group B (16.8%) and Group D (20.5%) (p=0.191).

Conclusions No significant difference in CBD stone recurrence rate and total biliary complication between cholecystectomy group and acalculous GB in situ group. Cholecystitis is more common in patients with GB stone. Patients without GB stone do not require unconditional preventive cholecystectomy.