ABSTRACT
BACKGROUND: The aim of this prospective study was the evaluation of the laparoscopic treatment of common bile duct stones (CBDS) and its indications. METHODS: Five hundred five patients who underwent laparoscopic treatment of CBDS from October 1990 to September 2006 were included in the prospective study. The mean age of the patients was 63 years (range = 19-93). Four hundred fifteen patients were classified ASA I and ASA II and 90 were ASA III and ASA IV. CBDS were suspected or diagnosed preoperatively in 373 patients (73.8%) and diagnosed at intraoperative cholangiography (IOC) in 132 patients (26.2%). A transcystic duct extraction (TCDE) was attempted in 254 patients (50.4%) and a primary choledochotomy in 251 patients (49.6%). Biliary drainage after choledochotomy was used in 148 cases (48.8%). RESULTS: TCDE was successful in 191 cases (75.2%). The 63 failures were managed by laparoscopic choledochotomy in 53 cases and by endoscopic sphincterotomy (ES) in 10 cases. A choledochotomy was thus performed in 304 patients and successful in 295 cases (97%). The nine failures were managed by six conversions to laparotomy (2%) and three postoperative ES. The overall success rate was 96.2%. The morbidity rate was 7.9% with 4.8% of local complications and 3.1% of general complications. The mortality rate was 1%. There were 14 residual stones (2.8%) that were managed by a second laparoscopy in two cases and by ES in 12 cases with four failures managed by laparotomy in one case and laparoscopy in three cases. CONCLUSION: Laparoscopic management of CBDS was effective in more than 96% of cases and particularly safe in ASA I and ASA II patients. It has the advantage over ES followed by laparoscopic cholecystectomy (LS) to be a one-stage procedure.
Subject(s)
Endoscopy, Gastrointestinal/statistics & numerical data , Gallstones/surgery , Laparoscopy/statistics & numerical data , Adult , Aged , Aged, 80 and over , Endoscopy, Gastrointestinal/methods , Female , Follow-Up Studies , Humans , Laparoscopy/methods , Length of Stay , Male , Middle Aged , Patient Selection , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The aim of this study was to evaluate the feasibility and results of laparoscopic management of common bile duct stones (CBDS). METHODS: From October 1990 to November 1996, 220 patients with CBDS have been managed laparoscopically. CBDS were suspected or diagnosed preoperatively in 130 patients (59.1%) and at intraoperative cholangiography (IOC) in 90 patients (40.9%). A transcystic duct extraction (TCDE) was attempted in 112 patients and a primary choledochotomy in 108 patients. RESULTS: TCDE was successful in 77 cases (68.8%). The 35 failures were treated by 29 laparoscopic choledochotomies, 1 intraoperative and 5 postoperative endoscopic sphincterotomies (ES). A choledochotomy was thus performed in 137 cases and was successful in 133 cases (97.1%). The four failures were managed by three laparotomies and one postoperative ES. The overall success rate was 95.5% (210/220). There was 4 deaths (0.9%) within the 1st postoperative month in ASA 3 patients and the morbidity rate was 9.1% (20/220). There were 7 residual stones (3.2%). CONCLUSIONS: Laparoscopic desobstruction of CBDS appears to be safe and effective and has the advantage to be a single-stage procedure. It could become in the future with refinement of instrumentation and skill of surgeons the best treatment for the majority of patients harboring CBDS.
