The risk factors for gallstone recurrence in patients with laparoscopic gallbladder-preserving cholelithotomy: a retrospective study of 297 patients

Background: Stone recurrence is a major problem in the treatment of gallstones with gallbladder preservation. This study aimed to elucidate the possible risk factors of gallstone recurrence after laparoscopic gallbladder-preserving cholelithotomy (LGPC). Method: A total of 297 patients who underwent LGPC for gallstones at Shanghai East Hospital from January 1, 2013 to December 31, 2013 were retrospectively studied to determine the recurrence rate and the surgery's possible risk factors. Following the LGPC, the patients were followed-up for 3 years. The first follow-up visit was 4 months after the LGPC, and thereafter a follow-up visit was carried out every 6 months. During each visit, the patients were clinically examined to look for signs of relapse, and an abdominal ultrasonography (USG) was performed to confirm the presence or absence of disease. The risk factors associated with gallstone recurrence were identified through a questionnaire, which recorded information such as age, sex, body mass index (BMI), duration of disease course, family history of gallstones, comorbid conditions (e.g, hyperlipidemia, diabetes, and hypertension), history of tauroursodeoxycholic acid (TUDCA) intake, physical activity after LGPC, and preference for fatty food. Results: During the 3 years of follow-up, gallstone recurrence was detected in 26 of the 297 (8.75%) LGPC patients. The maximum recurrence rate was found at the 1-year duration period (11 patients), followed by 3 years, 2 years, 6 months, and 4 months in 5, 4, 3, and 3 patients respectively. The risk factors associated with gallstone recurrence included a preference for fatty food, reduced physical activity and a long course of gallstone disease (>4 years). Other demographic factors (sex, age, BMI, family history of gallstones, a history of medication, and concomitant disease) had no significance on the recurrence of gallstones. Conclusion: The overall recurrence rate of gallstones after LGPC was 8.75% during 3-years of follow-up visits. The associated risk factors were a preference for fatty food, reduced physical activity, and long disease course. We suggest that the use of LGPC in patients with gallstones should be considered carefully because of stone recurrence. In addition, long term follow-up visits after LGPC are highly recommended. The present study was limited by the relatively short duration of the follow-up visits.