The majority of suspected bile duct stones can be managed at time of laparoscopic cholecystectomy

Abstract

Introduction: Choledocholithiasis can be cleared by either endoscopic retrograde cholangiopancreatography (ERCP) with cholecystectomy as a two-stage procedure or operative bile duct exploration at time of laparoscopic cholecystectomy. The objective of this study is to evaluate the management of choledocholithiasis at our surgical unit where bile duct stones are managed preferentially at time of laparoscopic cholecystectomy. Method: A retrospective review of all laparoscopic cholecystectomies at the Prince Charles Hospital (Brisbane, Australia) between 1 September 2015 and 30 September 2017 was performed. Patients with suspected choledocholithiasis were identified and their management was described. Result: A total of 690 laparoscopic cholecystectomies were performed during the study period. 674/690 (98%) had a successful cholangiogram performed. Of these patients, 69/674 (10%) had suspected choledocholithiasis on operative cholangiogram. Two patients had biliary stents from prior endoscopic retrograde cholangiopancreatography (ERCP) and had no further attempts at bile duct exploration. Saline flushing of the duct +/- intravenous buscopan or glucagon was successful in attaining a clear operative cholangiogram in 21/69 (30%) of cases. Transcystic catheter passage into the duodenum without the use of a basket was successful in 13/69 (19%) of cases. Transcystic catheter with the use of basket was successful in 18/69 (26%) of cases. The choledochoscope was used with a basket in 3 cases. There was one choledochotomy performed amongst these, and this patient had a transpapillary antegrade biliary stent placed. Sixteen patients had post-operative ERCP referrals made. 12/69 (17%) were due to failure to clear their bile ducts at surgery, two were for removal of pre-existing stents and another two were for removal of antegrade transpapillary stents placed at surgery. Conclusion: The majority of patients had their suspected choledocholithiasis managed at time of laparoscopic cholecystectomy.