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What is the better surgical treatment option for recurrent common bile duct stones?

Annals of Surgical Treatment and Research 2020년 99권 6호 p.329 ~ 336
박치영, 최성훈, 권창일, 조재희, 장성일, 이태훈, 한정호, 정석, 고광현,
소속 상세정보
박치영 ( Park Chi-Young ) - CHA University School of Medicine CHA Bundang Medical Center Digestive Disease Center
최성훈 ( Choi Sung-Hoon ) - CHA University School of Medicine CHA Bundang Medical Center Department of Surgery
권창일 ( Kwon Chang-Il ) - CHA University School of Medicine CHA Bundang Medical Center Digestive Disease Center
조재희 ( Cho Jae-Hee ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine
장성일 ( Jang Sung-Ill ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine
이태훈 ( Lee Tae-Hoon ) - Soonchunhyang University College of Medicine Soonchunhyang University Cheonan Hospital Department of Internal Medicine
한정호 ( Han Joung-Ho ) - Chungbuk National University College of Medicine Department of Internal Medicine
정석 ( Jeong Seok ) - Inha University School of Medicine Department of Internal Medicine
고광현 ( Ko Kwang-Hyun ) - CHA University School of Medicine CHA Bundang Medical Center Digestive Disease Center

Abstract


Purpose: Repeating endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent common bile duct (CBD) stones is problematic in many ways. Choledochoduodenostomy (CDS) and choledochojejunostomy (CJS) are 2 surgical treatment options for recurrent CBD stones, and each has different advantages and disadvantages. The aim of this study was to compare the 2 surgical options in terms of the recurrence rate of CBD stones after surgical treatment.

Methods: This retrospective multicenter study included all patients who underwent surgical treatment due to recurrent CBD stones that were not effectively controlled by medical treatment and repeated ERCP between January 2006 and March 2015. We collected data from chart reviews and medical records. A recurrent CBD stone was defined as a stone found 6 months after the complete removal of a CBD stone by ERCP. Patients who underwent surgery for other reasons were excluded.

Results: A total of 27 patients were enrolled in this study. Six patients underwent CDS, and 21 patients underwent CJS for the rescue treatment of recurrent CBD stones. The median follow-up duration was 290 (180?1,975) days in the CDS group and 1,474 (180?6,560) days in the CJS group (P = 0.065). The postoperative complications were similar and tolerable in both groups (intestinal obstruction; 2 of 27, 7.4%; 1 in each group). CBD stones recurred in 4 patients after CDS (4 of 6, 66.7%), and 3 patients after CJS (3 of 21, 14.3%) (P = 0.010).

Conclusion: CJS may be a better surgical option than CDS for preventing further stone recurrence in patients with recurrent CBD stones.

키워드

Choledochoduodenostomy; Choledochojejunostomy; Choledocholithiasis; Choledochostomy; Endoscopic retrograde cholangiopancreatography

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