[Exploration of biliary tracts for laparoscopy for treatment of choledocholithiasis]

Abstract

Background: Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis of choledocholithiasis is made in the preoperative work-up it is a common practice to refer patients to endoscopic retrograde cholangiography and endoscopic sphincterotomy. However, if the diagnosis is established during the intraoperative cholangiogram the surgeon confronts a therapeutic dilemma between laparoscopic common bile exploration, conversion to open surgery or post-operative endoscopic sphincterotomy.

Objective: We have opted to resolve the choledocholithiasis in only one session during the laparoscopic cholecystectomy, with the transcystic common bile duct exploration technique using the choledochoscope, or with laparoscopic choledochotomy. We report our early experience in terms of success of stone removal, operative time, morbidity, mortality and hospital stay.

Methods: from 1992 to 2003 we performed 460 laparoscopic cholecystectomies and using selective cholangiography in 138 patients (30%) we found 52 patients with common bile duct stones, for an incidence of 11.3%.

Results: Of this group we performed laparoscopic common bile duct exploration in 46 patients, and our success rate for stone removal was 95.6% (44 of 46) with only two failures related to multiple stones and impactation at the ampulla for a conversion rate of 4%. The mean operative time was 120 +/- 40 min. A morbidity of 8.6% was found, with no mortality. Hospital stay was 48 hrs. Mean recovery time was 7 days, and time to return to work 15 +/- 3 days.

Conclusions: We concluded that must of the patients with common bile duct stones found during laparoscopic cholecystectomy can be treated with success using the laparoscopic technique with choledochoscopy, without increased morbidity or mortality, and with a short hospital stay and recovery time similar to patients in whom only laparoscopic cholecystectomy is perform. According to our results we encourage that this method should become the primary strategy in the great majority of patients with common bile duct stones found during intraoperative cholangiography.