Selective Intraoperative Cholangiography and Single‐Stage Management of Common Bile Duct Stone in Laparoscopic Cholecystectomy

Abstract

There are still debates and controversies in the detection and the management of common bile duct (CBD) stones in the era of laparoscopic cholecystectomy (LC). This prospective study was performed to evaluate a single-stage management of CBD stone during LC. Between May 1998 and January 2000, 249 consecutive patients with gallstone and cholecystitis were enrolled in this study. The mean age was 52.5 +/- 12.4 years. Male to female ratio was 106:143. All patients underwent abdominal sonography and the determination of the serum biochemical profile preoperatively. Patients presented with sepsis or with total bilirubin > or = 6 ng/dL were excluded from the study. 244 (98%) patients underwent LC and 5 (2%) patients were converted to open cholecystectomy. Intraoperative cholangiogram (IOC) was only performed in patients who fulfilled our predetermined criteria. Among 90 patients who had IOC, only 23 patients had CBD stones that were removed either by transcystic duct stone extraction (61%) or CBD exploration (39%). The additional procedures to remove CBD stone did not prolong the hospitalization. There were four wound infections and one cystic stump leakage. One patient developed CBD stone during the follow-up period up to 37 months. Our study indicates that routine use of IOC during LC is not necessary. In addition, single-stage approach for the management of CBD stone during LC is feasible and should be considered by laparoscopic surgeons.