Laparoscopic choledocholithotomy for patients with common bile duct stones

Abstract

Objective To explore the safty and clinical efficacy of laparoscopic choledocholithotomy for the treatment of common bile duct stones. Methods The subjects of this retrospective study were 55 patients with choledocholithiasis who underwent surgery in the Third Affiliated Hospital of Sun Yat-sen University from August 2011 to August 2012. The informed consent of all patients were obtained and the ethics committee approval was recieved. According to the surgical procedures, 55 patients were divided into laparoscopic choledocholithotomy group (laparoscopic group) [25 cases; 14 males and 11 females; (53±14) years old] and the open common bile duct exploration group(open group) [30 cases; 16 males and 14 females; (57±14) years old]. Patients in the laparoscopic group underwent laparoscopic cholecystectomy+choledochendysis+fiber-choledochoscopic lithotomy+T tube drainage. Patients in the open group underwent cholecystectomy+ choledocholithotomy+T tube drainage. The operations and mortality in the two groups were observed. The operative time, blood loss, postoperative hospital stay and gastrointestinal function recovery time were compared by t-test. The percentage of application of postoperative analgesics (pethidine), the stone clearance rate and incidence of complications were compared by χ2 test. Results All operations were successful. No case in the laparoscopic group was converted to laparotomy. No death was observed. The median operative time in the laparoscopic group was (105±21) min, while the operative time in the open group was (112±19) min and no significant difference was observed between the two groups (t=-1.325, P>0.05). For the laparoscopic group, the blood loss was (53±18) ml, the gastrointestinal function recovery time was (1.5±0.6) d and the postoperative hospital stay was (6.3±1.1) d, which were significantly less than (117±36) ml, (2.6±0.8) d, (9.8±1.8) d respectively in the open goup (t=-10.157、-5.378、-8.614, all in P 0.05) . Complications were observed in 2 patients (8%) in the laparoscopic group, including pancreatitis and bile leakage. Six patients in the open group (20%) suffered complications, among which one developed pancreatitis, four developed wound infection and one suffered bile leakage. There was no significant difference between two groups for the complication incidence (χ2=1.580, P>0.05) . All were cured by conservative treatment. Conclusions Compared with the open common bile duct exploration, the laparoscopic choledocholithotomy is minimally invasive, safe, effective and fast-recovered in the treatment of common bile duct stones, and has the same effect as the open common bile duct exploration. Key words: Choledocholithiasis; Laparoscopes; Choledochoscope; Treatment outcome