A history of gastrectomy is a risk factor for choledocholithiasis in patients undergoing cholecystectomy: A single center retrospective study

Abstract

Aim

The incidence of cholelithiasis after gastrectomy is higher than that in the general population; however, the incidence and risk factors for choledocholithiasis have not been well reported. We aimed to assess the association between a history of gastrectomy and choledocholithiasis.

Methods

A total of 3025 patients who underwent cholecystectomy with or without choledocholithotomy between January 2006 and December 2020 at Kansai Medical University, Japan were included in this study. Patients were divided into a gastrectomy group with a history of gastrectomy (173 patients, 5.7%) and a control group having no history of gastrectomy (2852 patients, 94.3%).

Results

The incidence of choledocholithiasis was 61.8% and 22.2% in the gastrectomy and control groups, respectively, with a significantly higher incidence in the gastrectomy group (p < 0.0001). Multivariate analysis showed that age, sex, history of gastrectomy, and previous surgery except gastrectomy were risk factors for the development of choledocholithiasis, with a history of gastrectomy being the strongest risk factor (Odds Ratio 3.78, 95% Confidence Interval 2.71–5.27). The incidence values of choledocholithiasis in the Billroth I, Billroth II, and Roux-en-Y methods were 44.7%, 70.6%, and 69.7%, respectively, and were significantly lower in the Billroth I group than in the Roux-en-Y group (p = 0.009). The median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux-en-Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II.

Conclusion

Gastrectomy is a known risk factor for choledocholithiasis. Concomitant cholecystectomy during gastrectomy may be indicated in older men.