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March 1995

Common Bile Duct Exploration in the Era of Laparoscopic Surgery

Author Affiliations

From the Department of Surgery, The Fallon Clinic, St Vincent Hospital and The University of Massachusetts Medical School, Worcester.

Arch Surg. 1995;130(3):265-269. doi:10.1001/archsurg.1995.01430030035005

Objective:  To review the treatment and outcome of patients with common bile duct (CBD) stones who underwent cholecystecomy.

Design:  Prospective series of 700 consecutive laparoscopic cholecystectomies, with a mean follow-up of 22 months.

Setting:  University-affiliated community hospital.

Patients:  Eighty patients with documented CBD stones during a 42-month period (July 1990 to January 1994).

Interventions:  Laparoscopic CBD exploration (LCBDE) was performed with either choledochotomy and T tube (n=27) or transcystic duct choledochoscopy (n=33). Open CBDE (OCBDE) (n=16) and endoscopic sphincterotomy (n=16) were also employed.

Main Outcome Measures:  Documented removal of CBD stones and procedure-related complications.

Results:  Laparoscopic CBDE was successful in 60 (94%) of 64 attempted cases. Mean operating time was 149±40 minutes and length of hospital stay was 2.8±2.1 days. Six complications (10%) were recorded, including three retained stones (5%). In 11 of 16 patients undergoing OCBDE, CBD stones were discovered with intraoperative cholangiography after conversion to laparotomy was needed for completion of the cholecystectomy. One OCBDE was planned in a patient with suppurative cholangitis. Preoperative endoscopic sphincterotomy (n=11) was successful in four patients. Postoperative endoscopic sphincterotomy (n=5) was successful in four patients.

Conclusion:  With a protocol of routine cholangiography, LCBDE, and selective use of OCBDE (when LCBDE is not possible), the reliance on a second procedure (endoscopic sphincterotomy) can be minimized. Laparoscopic CBDE, a technically demanding operation, is possible at the time of laparoscopic cholecystectomy in the majority of cases, with a low complication rate and a short length of hospital stay.(Arch Surg. 1995;130:265-269)

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