An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland.

Abstract

To audit short- and long-term outcomes after laparoscopic common bile duct exploration (LCBDE) and factors influencing the success of the laparoscopic treatment. From January 1999 to December 2011, 288 patients (93 males) underwent a single-stage laparoscopic cholecystectomy combined with LCBDE in two Finnish Hospitals. Short-term outcome data were collected prospectively. Long-term outcomes were examined retrospectively. The main measures of outcome were the success of laparoscopic CBD stone clearance and recurrence of CBD stones in the long-term, with 30-day mortality, morbidity, and the length of postoperative hospital stay as secondary outcome measures. CBD stones were successfully removed by one-stage laparoscopic procedure in 232 of the 279 patients (83.2%) with verified CBD stones and after conversion to open surgery in additional 28 patients (93.2%). Nineteen patients (6.8%) having residual stones after surgery were successfully treated with postoperative ERCP. On multivariate analysis, the independent factors associated with a failed laparoscopic stone clearance were stone size over 7 mm [OR 3.51 (95% CI 1.53-8.03), p = 0.003], difficult anatomy [OR 18.01 (5.03-64.49), p < 0.001] and transcholedochal approach [OR 2.98 (1.37-4.47), p = 0.006]. Laparoscopic stone clearance also failed in all 11 patients having impacted stones at the ampulla of Vater. Cumulative long-term recurrence rate was 3.6% at 5 years and 6.0 % at 10 years. Thirty-day mortality was 0.3% and morbidity 12.2%. Postoperative hospital stay was median 2 (IQR 1-3) days after transcystic CBD removal and 4 (IQR 3-7) days after transcholedochal CBD removal, p < 0.001. Our results show that one-stage LC combined with LCBDE stone clearance is safe and effective in most patients thus reducing the number of additional, potentially dangerous endoscopic procedures. Moreover, large or impacted stones are a risk factor for failed stone clearance.