Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center.

Bahman Darkahi,Gabriel Sandblom,Håkan Liljeholm

doi:10.3389/fsurg.2016.00023

Abstract

The aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) through cholangiotomy with T-tube placement in one séance for common bile duct stones (CBDS). Between January 2005 and December 2010, a total of 99 patients with CBDS stones undergoing LCBDE with T-tube insertion at Enköping Hospital, Sweden, were registered prospectively. All patients were followed up by review of the patient records according to a standardized protocol. No severe intraoperative complications were registered. Four procedures required conversion to open cholecystectomy due to impacted stones or technical difficulty. The mean operative time was 194 min [(SD) 57 min]. The mean postoperative hospital stay was 4.8 days, SD 2.4 days. At secondary cholangiography, 2 (2%) retained stones were found. Two (2%) patients had minor bile leakage, which resolved spontaneously. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No death within 30 days after surgery was seen. No patient was readmitted with clinical signs of stricture. If performed by a surgeon familiar with the technique, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low.

Highlights

Since the introduction of laparoscopic cholecystectomy (LC) as a routine technique two decades ago, it has almost completely replaced open cholecystectomy as the procedure of choice for treating cholecystolithiasis
If calculi with a diameter of at least 5 mm were seen at peroperative cholangiography and the CDB had a minimum diameter of 6 mm, laparoscopic common bile duct exploration (LCBDE) was performed
The present study shows that LCBDE can be performed safely, with no significant risk for postoperative leakage, retained stones, or bile duct stricture

Summary

Introduction

Since the introduction of laparoscopic cholecystectomy (LC) as a routine technique two decades ago, it has almost completely replaced open cholecystectomy as the procedure of choice for treating cholecystolithiasis. The technique has gained general acceptance for treatment of symptomatic gallstone disease the world over. A factor that may complicate the procedure is the presence of common bile duct stones (CBDS). CBDS may be diagnosed prior to the procedure or encountered unexpectedly at peroperative cholangiography. The overall prevalence of CBDS in patients undergoing LC is 4–5% [1].

Methods

Results

Conclusion