Risk of recurrent biliary tract disease after cholecystectomy in patients with duodenal diverticula
M. E. Mackenzie, W. T. Davies, M. B. Farnell, A. L. Weaver and D. M. Ilstrup
Department of Surgery, Mayo Clinic, Rochester, Minn., USA.
OBJECTIVE: To determine if the presence of duodenal diverticula predisposes
to the development of common bile duct stones. DESIGN: Cohort study; median
follow-up, 10.0 years (25th and 75th percentiles, 5.2 and 16.1 years,
respectively). SETTING: Tertiary care center. PATIENTS: One hundred
fifty-seven patients with radiologically diagnosed duodenal diverticula who
had undergone cholecystectomy from 1950 through 1987 and were asymptomatic
at the initiation of follow-up. MAIN OUTCOME MEASURES: All patients were
followed up for evidence of recurrent biliary tract disease to the
following end points: (1) evidence of choledocholithiasis demonstrated by
radiologic surgical, or biochemical means and (2) clinical or biochemical
evidence of biliary pancreatitis. RESULTS: Of the 157 patients in the study
cohort, 13 patients were categorized as having had recurrent biliary tract
disease. Using the Kaplan-Meier survivorship method, the cumulative
probabilities of recurrent biliary tract disease in patients with
radiologically diagnosed duodenal diverticula were 3.6% at 5 years (95%
confidence interval, 0.5-6.9), 5.5% at 10 years (95% confidence interval,
1.5-9.4), and 10.2% at 15 years (95% confidence interval, 3.8-16.7). Age,
common bile duct exploration and choledochotomy, and the presence of common
bile duct dilatation were not found to be significantly associated with
recurrence based on a univariate analysis of risk factors by means of the
log-rank statistic. CONCLUSIONS: For patients with radiologically
diagnosed, second-portion duodenal diverticula, the risk of developing
recurrent bile duct stones after cholecystectomy is lower than has been
suggested in previous studies. In the absence of concurrent
choledocholithiasis, sphincterotomy or biliary bypass at the time of
cholecystectomy seems unwarranted.
