Common bile duct obstruction due to migrated gallbladder stone during laparoscopic cholecystectomy

Sung Won Jung, MD, Dong-Sik Kim, Young Dong Yu, Sung Ock Suh. Korea University Medical Center

Objective;

Occasionally, common bile duct (CBD) obstruction is occurred after laparoscopic cholecystectomy (LC) and migrated gallbladder stone during LC is one of the reasons. The aim of this study is to identify risk factors of gallbladder stone migration during LC.

Methods;

Between May of 2000 and December of 2013, 3054 patients were underwent LC for gallbladder stone and these patients are revealed without CBD stone before LC. Among of these patients, 95 patients experienced CBD obstruction due to migrated gallbladder stone during LC. Baseline characteristics of patients, operation-related parameters and pathologic findings were compared in the two groups (Obstruction, n=95; No obstruction, n=2959) and univariate and multivariate analysis were performed to find risk factors for gallbladder stone migration.

Results;

The baseline characteristics of patients such as sex, age and underlying disease were similar in the two groups. Preoperative dilatation of cystic duct or CBD, number of stones, combined GB polyp and gallbladder wall thickening were not related to gallbladder stone migration. In univariate analysis, largest size of stone (lesser than 3mm; 42% vs 11%, p=0.03) and operation time (over than 70 min; 61% vs 19%, p=0.04) were identified for risk factors to gallbladder stone migration. But, in the multivariate analysis, only largest size of stone (lesser than 3mm; odds ratio 2.4, 95% confidence interval 1.51-4.73, p=0.04) was related to stone migration.

Conclusion;

Our data suggest that better effort is essential to avoid migration of gallbladder stone to CBD during LC for small size gallbladder stone.