cbd dilatation after cholecystectomy

December 15, 2021 By admin Off

Methods: Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively.

Purpose: Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year.

Conclusion: Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.

Results: The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after cholecystectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm.

Keywords: Cholecystectomy; Common bile duct; Dilatation; Ultrasound.

The CBD diameters that were measured at each point were expressed as mean and standard deviation, and the change was investigated by t-test. The changes of a single patient before, 6 months after, and 12 months after the surgery were analyzed using a paired t-test wherein the P-value results of less than 0.05 were interpreted as significant.

Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively.

Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year.

INTRODUCTION.

Common bile duct (CBD) diameter increase 12 months after surgery.

Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.

After a hypothesis suggested by Oddi in 1887, many studies reported that the physiological dilatation of the bile duct after cholecystectomy was due to the disappearance of the gallbladder’s reservoir function. However, the frequency and degree of bile duct dilatation after gallbladder resection are reported differently. In addition, since most of the reported studies were based on the western population, it is assumed that these results may be different in the eastern population, who frequently show anomalous union of pancreaticobiliary duct (AUPBD) and a high incidence of bile duct stones. However, there have only been a few studies reported thus far.

Before surgery, 82.8% of patients had a CBD diameter of less than 5 mm while 17.2% of patients were in the 5 to 6.9 mm range making the mean diameter 4.1 ± 1.1 mm. The CBD diameter was found to increase by age. Eight patients 60 years or older had CBD diameters of 4.5 ± 0.8 mm compared to 56 patients less than 60 years of age with CBD diameters of 4.1 ± 1.8 mm (P < 0.05). Other than that, there were no significant differences observed in relation to sex or gallbladder disease type.

3 Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

3 Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

The present study investigated the CBD diameter of patients having normal bile ducts for up to 1 year after getting a cholecystectomy. A bile duct dilatation of more than 7 mm in 30% of the patients was observed, while no patients had bile duct dilatation of more than 10 mm. All of the bile duct dilatation patients were asymptomatic while clinical characteristics that can be differentiated from the others were not observed.

Jae-Woon Choi.

The present study aims to determine the physiological change of the bile duct by measuring the diameter of the common bile duct (CBD) in patients who had laparoscopic cholecystectomy for gallbladder stones or gallbladder polyps.

Forty-five patients had follow-up exams 6 months after surgery and out of those 35.6% had CBD diameter measurements of less than 5 mm while 40.0% measured between 5.1 to 6.9 mm with a mean diameter of 5.7 ± 1.8 mm. In 11 patients (24.4%), the CBD diameter was more than 7 mm (range, 7.0 to 9.2 mm), but no patient had a measurement of more than 10 mm.

3 Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

In the present study, the CBD diameter at 6 months and at 12 months after surgery showed increases of 1.6 mm and 2.0 mm, respectively, and 20% of the patients displayed more than a 3 mm dilatation compared to that before surgery. These results showed more CBD dilatation and frequency than previous studies. Eastern populations showed that the CBD dilatation was frequently accompanied by ampullary diverticulum, biliary sludge, or AUPBD. However, the patients showing a biliary dilatation in the present study were found to be asymptomatic with normal LFTs. Precision was applied to the present study from the perspective in that the tests were performed by a single skilled diagnostic radiologist using abdominal ultrasonography. Moreover, since the present study was performed by contrasting all CBD regions and based on repeated measurement values that measured the widest CBD diameter, it can be judged to be meaningful and accurate.

2 Department of Radiology, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

Abstract.

Before surgery, the CBD diameters of 6 months and 12 months after surgery show an increase of 45.3 ± 41.8% and 52.7 ± 43.4%, respectively (baseline vs. post 6 months, P < 0.0001; baseline vs. post 12 months, P < 0.000; by paired t-test). CBD diameter increased more than 3 mm in 7 patients (20%) 6 months after surgery and in 5 patients (20%) 12 months after surgery. Among the 7 patients at 6 months after surgery, 4 patients showed a reduction in diameter at the 12-month examination, and the 3 patients that were normal at the time, showed a CBD diameter increase 12 months after surgery ( Fig. 1 ). At the follow-up examination, any specific clinical characteristics of the patients who showed more than a 3 mm dilatation were not discovered and they remained in an asymptomatic state by showing normal LFTs.

The sex, age and diagnosed diseases of the patients were investigated and the CBD diameter was measured, 6 months after and 12 months after surgery. This was done by one specialist of diagnostic radiology using a single type of ultrasonography (Combison 310, KretzTechnik, Zipf, Austria). The CBD diameter was measured in 0.1 mm scale at the widest point of extrahepatic bile ducts. The changes of CBD diameter before and after surgery were measured from the same patient. The normal range of the CBD diameter was defined to be less than 6 mm; and the frequencies of being less than 5.0 mm, 5.1 to 6.9 mm, and more than 7.0 mm were measured. The change of CBD diameter was expressed in percentages (%), based on the measurements before the surgery and during the follow-up periods. In particular, the clinical characteristics of patients who showed bile duct to be over 7 mm and a duct dilatation of more than 3 mm at the follow-up examinations were investigated.

The patients who received laparoscopic cholecystectomy from one surgeon at the Chungbuk National University Hospital between January and December in 2007. Patients who previously underwent abdominal surgeries or ERCP, showed abnormal liver function tests (LFTs) or pancreatitis at the time of surgery, or showed a bile duct diameter of more than 7 mm were excluded from this study.

In studies involving eastern populations, a cross sectional study investigating the CBD diameter by using abdominal ultrasonography of Korean patients revealed the CBD diameter was 8.1 mm in the gallbladder resected group, which was wider than the 4.5 mm in the normal population [14]. One prospective study performed in Hong-Kong, investigating the CBD diameter before and after cholecystectomy by ERCP, revealed that 88.6% of 35 patients showed a dilatation of about 2.0 mm, and the degree of dilatation increased proportionally to time passed for the period of 4 to 14 months [15]. However, in a Taiwanese study, 197 patients revealed a slight CBD dilatation from 5.9 to 6.1 mm, and the degree of dilatation was not related to time passage [16]. Since the above studies on eastern populations applied different imaging techniques and showed different results, bile duct change after gallbladder resection still remains in dispute.

Although there is no official guideline, a bile duct diameter of less than 6 mm is generally considered to be a normal size in adults younger than 65 years of age, and more than 7 mm is considered abnormal [18]. Bile duct size is not largely affected by sex, body weight and height of the patient, but reported to have a major correlation with age as there was an increase of 0.3 to 0.6 mm for patients of 10 years difference [19,20]. According to a study that investigated the CBD diameter of 230 healthy Koreans, results showed that they had CBD diameters of 4.5 ± 1.8 mm while 95% of the investigated populations had less than 7.3 mm [14].

There were 31 patients who had follow-up exams 12 months after surgery and CBD diameter results showed that 29% had less than 5 mm and 42.0% ranged from 5.1 to 6.9 mm, with a mean diameter of 6.1 ± 1.7 mm. In 9 patients (29.0%), the CBD diameter was more than 7 mm (range, 7.1 to 9.3 mm), but no patient had a measurement of more than 10 mm.

All 234 patients who had cholecystectomy at our hospital between October 1985 and April 1994 were included in this study. The luminal diameter of the proximal segment of the common bile duct was measured on antero-posterior transverse sonograms 4-15 days before cholecystectomy. In all patients, the luminal diameter was measured again on sonograms obtained 7-2160 days after surgery (mean, 393 days; median, 180 days; mode, 360 days). A diameter of 6 mm or less was considered normal. This study contained 197 patients with a normal common bile duct (< or = 6 mm) and 37 patients with a dilated common bile duct (> 6 mm).

The purpose of this study was to determine whether the common bile duct dilates after cholecystectomy.

The mean diameter of the common bile duct measured on sonograms was 5.9 mm before cholecystectomy and 6.1 mm after cholecystectomy. This difference was statistically significant (p < .05). The diameter of the common bile duct increased in 110 patients, decreased in 61 patients, and stayed the same in 63 patients. Of the 234 patients, 197 (84%) had a normal preoperative diameter of the common bile duct, whereas 167 (71%) had a common bile duct with a normal diameter postoperatively.

The diameters of the common bile duct as measured on sonograms increase slightly after cholecystectomy. Most patients do not have significant compensatory dilatation of the duct after cholecystectomy.