417 Recurrent Bile Duct Stones After Laparoscopic Bile Duct Explorations and Cholecystectomy: Incidence, Management and Risk Factors

Abstract Aim Recurrence of common bile duct stones (CBDS) following laparoscopic cholecystectomy (LC) and bile duct exploration (LCBDE) is an important long-term outcome. This study evaluates the incidence and aims to identify modifiable risk factors in a high-volume centre. Method A prospectively maintained database spanning 30 years was analysed. Recurrences were identified through clinical and biochemical suspicion, with or without MRCP confirmation, and included even if no intervention was required. Electronic records were reviewed in 2020 and 2023 to capture missed episodes. Results 1,447 patients undergoing LCBDE. 56 (3.8%) with a median age of 72 years developed suspected stone recurrence after a median of 24 months (range: 5–220). Twelve patients (21.4%) resolved without intervention. 44 (78.6%) had 59 confirmed recurrence episodes, six settling conservatively. 53 episodes required 63 ERCPs. Thirteen patients (23.2%) suffered multiple recurrences. 4,693 patients had LC only, 22 recurrence episodes occurred in 11 (0.23%), half resolving spontaneously and 11 requiring ERCPs. LCBDE patients who had recurrence were more likely to be males, older, with more previous ERCPs and more dilated ducts on initial ultrasound and required more choledochotomies for larger stones. Conclusions Recurrent CBDS occurred in 3.8% of LCBDE patients (3% confirmed), markedly lower than reported after sphincterotomy. Glucagon may assist with small stone passage when recurrence is suspected. Multiple recurrences occurred in 23.2% of patients, warranting consideration of stone dissolution therapy. This study suggests that recurrence after LCBDE can be significantly reduced through the avoidance of preoperative sphincterotomy and preferential use of the transcystic approach.