Laparoscopic exploration of common bile duct: A solution to difficult choledocholithiasis

Abstract

Objective: To evaluate the role of laparoscopic exploration of common bile duct (LECBD) in the management of common bile duct stone, particularly for patients with failed endoscopic extraction and patients younger than 60 years old.Method: Prospective data of laparoscopic exploration of common bile duct during 1995–1999 were analysed.Results: During 1995–1999, 27 laparoscopic exploration of common bile duct (LECBD) were performed in patients with concomitant gallstone and common bile duct stone, in which half of these LECBD were performed after unsuccessful endoscopic retrieval (13 patients). LECBD was also indicated in patients younger than 60 years old (14 patients) because there was a concern about the potential long‐term complications of papillotomy‐like papillary stenosis and ascending cholangitis. One transcystic duct exploration and 26 choledochotomies were performed. Mean operating time was 138.7 min (70–300 min) and additional procedures included 19 laparoscopic ultrasounds (LUS), three laparoscopic intraoperative cholangiograms (LIOC) and two laparoscopic choledochoduodenostomies. Stone clearance rate was 96% with only one exception. Complications were encountered in nine patients (33%) and one patient died of sepsis subsequent to major bile leak (3.7%). Complications included bile leak/stent migration/collection (4), wound infection (3), minor wound bleeding (1) and self‐limiting postoperative intestinal obstruction (1).Conclusion: LECBD has a high success rate of ductal clearance in patients with ‘difficult common bile duct stones’ despite unsuccessful attempts at endoscopic extraction.