Outcome of gallbladder preservation in surgical management of primary bile duct stones

AIM:To evaluate the methods and outcome of gallbladderpreservation in surgical treatment of primary bile duct stones.METHODS:Thirty-five patients with primary bile duct stonesand intact gallbladders received stone extraction by twooperative approaches,23 done through the intrahepatic ductstump(RBD-IDS,the RBD-IDS group)after partialhepatectomy and 12 through the hepatic parenchyma byretrograde puncture(RBD-RP,the RBD-RP group).Thegallbladders were preserved and the common bile duct(CBD)incisions were primarily closed.The patients were examinedpostoperatively by direct cholangiography and followed upby ultrasonography once every six months.RESULTS:In the RBD-IDS group,residual bile duct stoneswere found in three patients,which were cleared by acombination of fibrocholedochoscopic extraction andlithotripsy through the drainage tracts.The tubes wereremoved on postoperative day 22(range:16-42 days).Inthe RBD-RP group,one patient developed hemobilia andwas cured by conservative therapy.The tubes were removedon postoperative day 8(range:7-11 days).Postoperativecholangiography showed that all the gallbladders were wellopacified,contractile and smooth.During 54(range:6-120months)months of follow-up,six patients had mildlythickened cholecystic walls without related symptoms andfurther changes,two underwent laparotomies because ofadhesive intestinal obstruction and gastric cancerrespectively,three died of cardiopulmonary diseases.Nostones were found in all the preserved gallbladders.CONCLUSION: The intact gallbladders preserved after surgical extraction of primary bile duct stones will not develop gallstones. Retrograde biliary drainage is an optimal approach for gallbladder preservation.