Laparoscopic treatment of common bile duct stones.

BACKGROUND/AIMS: Laparoscopic exploration of the common bile duct is technically possible. The aim of this prospective study was to evaluate the feasibility of the different techniques of laparoscopic treatment of common bile duct stones and their complications. MATERIALS AND METHODS: From October 1990 to December 1995, 161 patients, age from 18 to 92, underwent a laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 82 patients and was successful in 55 (67%). The failures were treated by 22 laparoscopic choledochotomies and in five patients by postoperative endoscopic sphincterotomy. A choledochotomy was performed in 101 cases and was successful in 97 (96%). The failures were treated by three laparotomies with a failure of intra-hepatic stone extraction and one postoperative endoscopic sphincterotomy. There were four residual lithiasis treated with endoscopic sphincterotomy. There were two failures treated one by laparotomy and one by laparoscopy. The total success rate was 92% (148/161). RESULTS: There was no postoperative mortality. There were five local complications, two abscesses, one liver injury, one small hemorrhage at the trocar site, and one pain lasting for more than 48 hours. There were seven general complications: two cardiac failures (medical treatment), one severe pancreatitis, one digestive hemorrhage, one psychiatric disorder, and two postoperative ileus. The total morbidity rate was 7.4% (12/161). Mean hospital stay was 7.6 days (2-36). CONCLUSIONS: Laparoscopic exploration of the common bile duct appears to be safe and effective. It could be included in the protocol of management of choledocholithiasis.

[Laparoscopic cholecystectomy in the elderly patient]. / Cholécystectomie coelioscopique chez le sujet âgé.

Biliary surgery in the elderly is associated with a high morbidity and mortality rate. The aim of this prospective study is to determine the complications or benefits of laparoscopic cholecystectomy in patients over 75. From December 1989 to July 1992, 60 women and 15 men, all aged over 75, underwent laparoscopic cholecystectomy. 32 (43%) were at high surgical risk. In one half of cases, complications were present (30 cases of acute cholecystitis and 13 cases of choledocolithiasis). 10 underwent endoscopic sphincterotomy preoperatively and 4 patients with common bile duct stones were treated by laparoscopy during the same operating time. Eight conversions were necessary because of inflammatory process. The global morbidity rate was 10.6%. Local complications were: 1 wound abscess, 1 wound dehiscence, 2 biliary leaks and 2 cases of bleeding at puncture sites. The general complications concerned the respiratory tract except for one case of urinary tract infection. The mortality rate was zero. Laparoscopic cholecystectomy seems to be better tolerated than laparotomy. It allows curative treatment of gallstones, complicated or not, with a low morbidity rate.

[Laparoscopic treatment of common bile duct calculi]. / Traitement laparoscopique de la lithiase de la voie biliaire principale.

Laparoscopic exploration of the common bile duct is now technically possible. This prospective study evaluates the feasibility of the different techniques and their complications. From January 1990 to March 1995, 140 patients, aged from 22 to 92, underwent laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 70 patients and was successful in 46 (65.7%). The failures were treated by 19 laparoscopic choledochotomies and 5 postoperative endoscopic sphincterotomies. A choledochotomy was performed in 89 cases and was successful in 85 (94.4%). The failures were treated by 3 laparotomies and 2 postoperative endoscopic sphincterotomy. The total success rate was 92.8% (130/140). The 5 local complications were pain (1), liver injury (1), and wound abscess (2), bleeding from a trocar site. Heart failure (medical treatment) (2), gastrointestinal haemorrhage from intestinal angiomas, severe pancreatitis after transcystic failure and psychiatric disorders were the 5 general complications. The total morbidity rate was 7.1%. There were 2 residual common bile duct stones. The mortality rate was 0. Mean hospital stay was 7.8 days. Laparoscopic exploration of the common bile duct appears to be safe and effective and should be included in the management protocol of choledocholithiasis.