Laparoscopic Common Bile Duct Exploration: Practical Application | Hepatobiliary Disease | JAMA Surgery | JAMA Network
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April 1998

Laparoscopic Common Bile Duct Exploration: Practical Application

Author Affiliations

From the Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.

Arch Surg. 1998;133(4):448-451. doi:10.1001/archsurg.133.4.448

Objective  To evaluate the effectiveness of laparoscopic common bile duct exploration in unselected patients.

Design  Consecutive sample.

Setting  Tertiary care general hospital.

Patients  Three hundred and two patients with symptomatic cholelithiasis presenting to a single surgeon during a 5-year period.

Interventions  Laparoscopic cholecystectomy, cholangiography, and common bile duct exploration.

Main Outcome Measures  Successful laparoscopic cholecystectomy and common bile duct exploration.

Results  Three hundred and two consecutive patients underwent cholecystectomy for symptomatic cholelithiasis; 280 of the procedures were successfully completed laparoscopically. Cholangiography was attempted in 269 patients, was successful in 239, and revealed evidence of choledocholithiasis in 25. Preoperative ultrasonography and liver function tests predicted the presence of common bile duct stones in 24% and 32% of patients, respectively. Seven of the patients with choledocholithiasis presented with biliary colic, 7 with biliary colic and jaundice, 8 with acute cholecystitis (3 with gallbladder perforation), 1 with acute cholecystitis and jaundice, and 2 with gallstone pancreatitis. Four of 5 patients underwent successful transcystic exploration with a biliary Fogarty catheter, 12 of 16 patients underwent successful transcystic choledochoscopy and stone basket extraction, and all 4 attempts at choledochotomy and choledochoscopic stone basket extraction were successful, for a total success rate of 80% with laparoscopic common bile duct exploration. One of the failures was converted to an open procedure, and 4 of the failures had successful postoperative endoscopic retrograde cholangiopancreatography and extraction of stones.

Conclusions  Laparoscopic cholecystectomy and common bile duct exploration is a highly successful procedure for the management of common duct stones in an unselected group of patients. Choledochotomy with choledochoscopy is the preferred method of common bile duct exploration.