RISK OF RECURRENT BILIARY-TRACT DISEASE AFTER CHOLECYSTECTOMY IN PATIENTS WITH DUODENAL DIVERTICULA

Objective: To determine if the presence of duodenal diverticula predis poses to the development of common bile duct stones. Design: Cohort st udy; median follow-up, 10.0 years (25th and 75th percentiles, 5.2 and 16.1 years, respectively). Setting: Tertiary care center. Patients: On e hundred fifty-seven patients with radiologically diagnosed duodenal diverticula who had undergone cholecystectomy from 1950 through 1987 a nd were asymptomatic at the initiation of follow-up. Main Outcome Meas ures: All patients were followed up for evidence of recurrent biliary tract disease to the following end points: (1) evidence of choledochol ithiasis 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 categorize d as having had recurrent biliary tract disease. Using the Kaplan-Meie r survivorship method, the cumulative probabilities of recurrent bilia ry tract disease in patients with radiologically diagnosed duodenal di verticula 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 year s (95% confidence interval, 3.8-16.7). Age, common bile duct explorati on and choledochotomy, and the presence of common bile duct dilatation were not found to be significantly associated with recurrence based o n a univariate analysis of risk factors by means of the log-rank stati stic. Conclusions: For patients with radiologically diagnosed, second- portion duodenal diverticula, the risk of developing recurrent bile du ct stones after cholecystectomy is lower than has been suggested in pr evious studies. In the absence of concurrent choledocholithiasis, sphi ncterotomy or biliary bypass at the time of cholecystectomy seems unwa rranted.