Post-Cholecystectomy Choledocholithiasis: Analysis of 22 Cases

Year 1978, Volume: 31 Issue: 4, 1301 - 1312, 31.12.1978

İsmail Kayabalı

https://izlik.org/JA54US28ER

Abstract

Objective To evaluate clinical features, diagnostic methods, surgical management, and outcomes in patients presenting with common bile duct stones after cholecystectomy.

Methods We retrospectively reviewed 22 patients (11 men, 11 women; age 29–65, mean 46) treated for post-cholecystectomy choledocholithiasis between 1957 and 1977. Interval from initial surgery to presentation averaged 5.2 years (range 10 days–15 years). All underwent liver function tests, ultrasound or cholangiography, and operative exploration.

Results The most common symptom was biliary pain (86%), followed by jaundice (68%), fever (45%), and biliary colic (45%). Extrahepatic bile duct dilatation appeared in 81.5% radiologically; stones were directly visualized in 45%. Surgical treatments included T-tube drainage (68%), lateral-lateral choledochoduodenostomy (23%), sphincteroplasty (4.5%), and perihepatic neurectomy (4.5%). Postoperative complication rate was 27%; mortality 9% (two deaths from liver failure and pancreatitis). At follow-up, 77.5% were symptom-free, 9% experienced recurrence, and 4.5% had improvement only.

Conclusion Post-cholecystectomy bile duct stones present many years after initial surgery. Accurate preoperative diagnosis (80%) and tailored surgical management—particularly addressing duct dilatation—are vital to minimize recurrence and maximize cure.

Keywords

Post-cholecystectomy choledocholithiasis , Common bile duct stones , T-tube drainage , Choledochoduodenostomy , Sphincteroplasty

Post-Kolesistektomik Kolodokolitiazis: 22 Olgunun Analizi

https://izlik.org/JA54US28ER

Abstract

Amaç Kolesistektomi sonrası ortaya çıkan safra yolları taşlarının klinik bulguları, tanı yöntemleri, cerrahi tedavisi ve sonuçlarını değerlendirmek.

Yöntem 1957–1977 yılları arasında post-kolesistektomik kolodokolitiazis tanısıyla opere edilen 22 hasta (11 erkek, 11 kadın; yaş 29–65, ort. 46) geriye dönük incelendi. İlk ameliyatla başvuru arasındaki ortama süre 5,2 yıl (10 gün–15 yıl), klinik bulgular, laboratuvar, görüntüleme ve cerrahi raporları kaydedildi.

Bulgular Başlıca belirtiler; kolik ağrı (%86), sarılık (%68), ateş (%45) ve bulantı/kusma (%50) idi. Radyolojik olarak ekstrabiliyer kanallarda %81,5 oranında genişleme, %45 oranında taş tespit edildi. Cerrahi yaklaşımlar arasında T-tüp drenajı (%68), lateral-lateral koledokoduodenostomi (%23), sfinkteroplasti (%4,5) ve perihepatik nörektomi (%4,5) yer aldı. Postoperatif komplikasyon oranı %27, mortalite %9 oldu. Takipte hastaların %77,5’i tamamen iyileşti, %9’unda nüks, %4,5’inde düzelme sınırlı kaldı.

Sonuç Safra taşları kolesistektomi sonrasında yıllar içinde ortaya çıkabilir. Preoperatif tanıda %80 başarı, cerrahi planda ise safra yolları genişlemesinin giderilmesine yönelik girişimler nüks oranını azaltır ve uzun dönemde yüksek şifa sağlar.

Keywords

Post-kolesistektomi kolodokolitiazis , Safra yolları taşları , T-tüp drenajı , Koledokoduodenostomi , Sfinkteroplasti

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