Laparoscopic Management of Common Bile Duct Stones

Abstract

Introduction: Common bile duct(CBD) stones are found in approximately 16% of the patients undergoing laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones wasendoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the besttreatment for CBD stones is a matter of debate and it continues to evolve. The objective of the presentstudy was to determine whether laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stageoption for the management of CBD stones. Patients and methods: All patients were done in our surgery department. Out of the 450 laparoscopiccholecystectomies between 2012-2015,we did selective intraoperative cholangiogram in 45 patients(10%) who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with orwithout CBD stone on sonography or having the history of recent jaundice/ pancreatitis. If CBD stonewas found, either a transcystic or transcholedochal exploration was done depending on the size, site,number of stones and CBD diameter. Choledochotomy was closed over a t-tube in few numberof patients. Primary closure of CBD was done in the majorityof patients and in one patient we placed an antegradestent and in another one we placed endoscopic stent into the CBD laparoscpically which was removed afterfour weeks. Results: Till date we have performed LCBDE in 34 patients. Transcystic exploration wasdone in 10 patients and transcholedochal exploration was done in 20 cases out of which 2 patientshad minor biliary leak which settled on conservative treatment in 2-3 days. Four patients requiredconversion to open surgery as there were multiple stones. We did not have any major complication andon 6 months follow-up in 83.3% patients, none was found to have residual stones. Conclusion: Treatment of CBD stones depends on the resources available, technical limitations and the surgeon’sexpertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the managementof CBD stones.