Laparoscopic cholecystectomy and choledocholithotomy in patients with a previous gastrectomy

BACKGROUND: An increased incidence of cholelithiasis has been widely report ed after truncal vagotomy and after gastric resection. In the early phase o f patient selection, previous gastrectomy has been considered a relative co ntraindication to laparoscopic cholecystectomy (LC). In this study, we exam ined the management of LC in patients with previous gastrectomy. STUDY DESIGN: LC was attempted on 1,260 consecutive patients. Of these pati ents, 29 had a previous gastrectomy. Surgical procedures that had been perf ormed included Billroth I gastrectomies (15), Billroth II gastrectomies (10 ), and total gastrectomies (4). There were 23 cases of cholelithiasis, 4 ch ronic cholecystitis, 2 gallbladder polyps, 1 porcelain gallbladder, and 1 g allbladder cancer. Nine patients were diagnosed with stones in their common bile duct or common hepatic duct. RESULTS: Preoperatively, seven of nine patients with common bile duct stone s were subjected to endoscopic sphincterotomy, and the stones were removed successfully from five of these patients. In the remaining two patients, co mmon bile duct stones were removed by laparoscopic choledocholithotomy by c holedochotomy. The LC was completed in 26 patients (90%) who had undergone previous gastrectomy. In 449 patients who had previous abdominal surgery wi thout a gastrectomy, only 4 patients (0.9%) required open surgery. In contr ast, three patients (10%) with previous gastrectomy required open surgery. No major complications were recorded in this study series, and no residual or retained stones were seen during a followup period of 3 months. CONCLUSIONS: Clear visualization of anatomic structures and landmarks, and scrupulous hemostasis are needed to perform a safe LC in these patients. We conclude that in our study patients, a previous gastrectomy is considered an indication for LC and laparoscopic choledochotomy. (J Am Coll Surg 2001; 193:614-619. (C) 2001 by the American College of Surgeons).