title: Common bile duct exploration in the era of laparoscopic surgery.
abstract: OBJECTIVE
  To review the treatment and outcome of patients with common bile duct (CBD) stones who underwent cholecystectomy.
  
  
  METHODS
  Prospective series of 700 consecutive laparoscopic cholecystectomies, with a mean follow-up of 22 months.
  
  
  METHODS
  University-affiliated community hospital.
  
  
  METHODS
  Eighty patients with documented CBD stones during a 42-month period (July 1990 to January 1994).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Fallon Clinic, St. Vincent Hospital, Worcester.
authors.forename: M E
authors.initials: ME
authors.lastname: Stoker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003135:Common Bile Duct / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care; D007440:Intubation / Q000295:instrumentation; D007902:Length of Stay; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic; D013997:Time Factors; D016896:Treatment Outcome