KUMJ | VOL. 24 | NO. 2 | ISSUE 95 | APRIL - JUNE, 2026

Choledocholithiasis After Cholecystectomy in a Tertiary Care Center: A Retrospective Study in Nepal
Gurung RB, Pathak S, Poudel P, Sapkota V, Jha PK, Kalauni D, Adhikari S, Sapkota P

Abstract:
Background Choledocholithiasis following cholecystectomy refers to the presence of gallstones within the common bile duct, which may result from stones retained at the time of surgery, arising from a residual gallbladder remnant, or forming de novo within the bile duct. While most cases are observed within three years postoperatively, this complication, though uncommon, may also manifest several years after the procedure. Objective To evaluate the clinical and demographic characteristics, type of initial surgery, current diagnostic modalities, interval from cholecystectomy to presentation, and treatment approaches in patients with post-cholecystectomy choledocholithiasis. Method A retrospective observational study was conducted by reviewing hospital records of patients who had a history of cholecystectomy and later diagnosed with choledocholithiasis between January 2023 and April 2024. The study was conducted after ethical approval from the Institutional Review Committee, Kathmandu University School of Medical Sciences (IRC, KUSMS), with an approval number of 154/24. Variables such as age, gender, type of past surgery, current diagnostic methods, CBD diameter, Stone size, time interval from cholecystectomy to presentation with choledocholithiasis, and treatment approaches were analyzed using descriptive statistical methods. Continuous variables were summarized as mean ± standard deviation (SD) and range, while categorical variables were presented as frequencies and percentages. Result Among 287 patients with post-cholecystectomy choledocholithiasis, there was a female predominance (61.67%). The mean age was 52.29 +/- 22.02 years (range: 11–87 years). The mean time from surgery to presentation was 103.6 months (range: 0.5–288 months). Most patients presented with jaundice, abdominal pain, and vomiting. Ultrasound was used mostly (n=203), followed by MRCP(n=77), for the diagnosis of choledocholithiasis. ERCP was the treatment for most of the patients (n=260), with a few cases (n=27) requiring surgical intervention. Conclusion Choledocholithiasis in post-cholecystectomy patients occured with female predominance and had a relatively long latency period in Nepalese population. Health professionals should maintain a high index of suspicion for choledocholithiasis in post-cholecystectomy patients to ensure timely diagnosis and management.
Keyword : Calculus, Common bile duct, Choledocholithiasis, Post-cholecystectomy, Nepal