Biliary tract imaging for retained calculi after laparoscopic cholecystectomy: is risk stratification useful?

The aim of this study was to determine the incidence of common bile duct (CBD) calculi patients undergoing laparoscopic cholecystectomy (LC) without routine intraoperative cholangiography (IOC) and the usefulness of risk stratification in guiding appropriate biliary tract imaging. Five hundred forty consecutive LCs were performed during the 12-month study period. Four hundred fifty-eight (84.8%) patients with low risk of CBD stones proceeded immediately to LC. Forty-four (8.1%) high-risk patients underwent endoscopic retrograde cholangiopancreatography (ERCP). Thirty-four (6.3%) moderate risk patients underwent magnetic resonance cholangiopancreatography. Four (0.7%) patients had an equivocal risk with 2 undergoing IOC. The preoperative incidence of CBD stones was 29/540 (5.4%), while 11 patients (2.04%) were readmitted with retained CBD calculi and underwent successful stone extraction with ERCP. The incidence of retained CBD calculi after LC without IOC is low. Risk stratification helps to accurately predict CBD stones and facilitates appropriate and cost-effective use of ERCP and magnetic resonance cholangiopancreatography.