RAPID FORMATION OF CHOLESTEROL CRYSTALS IN GALLBLADDER BILE IS ASSOCIATED WITH STONE RECURRENCE AFTER LAPAROSCOPIC CHOLECYSTOTOMY

Laparoscopic cholecystotomy (LCT) with subsequent extraction of gallst ones and primary closure of the gallbladder has been introduced as an alternative therapy for patients with cholecystolithiasis and preserve d gallbladder function. However, stone recurrence has to be considered as a major drawback that might be related to lithogenic factors of ga llbladder bile or the composition of gallbladder stones. Therefore, th ese were studied in relation to stone recurrence within an observation period of 1 to 5 years (median, 3.6 years) in 50 patients after LCT. The concentrations of total and individual bile acids, phospholipids, cholesterol, total lipids, mucin, protein, and the cholesterol saturat ion indices in gallbladder bile were not significantly different betwe en 10 patients with and 40 patients without stone recurrence. However, the crystal observation time was significantly (P < .02) shorter (ran ge, 1-2 days; median, 1.5) in the bile of patients with stone recurren ce compared to those without (range, 1-21 days, median 3.5). Moreover, all 10 stone recurrences were observed in the 28 patients with a crys tal observation time in the bile of less than or equal to 2 days (appr oximate annual risk: 12%-15%), and no recurrences were observed in the 22 patients with a crystal observation time greater than 2 days (P < .0001) or in patients with pigment stones. The rapid formation of chol esterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These are most likely cholesterol sto nes and, therefore, are amenable to oral bile-acid prevention or treat ment.