Common bile duct exploration in the era of laparoscopic surgery.
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.
Stoker
M E
ME
Department of Surgery, Fallon Clinic, St. Vincent Hospital, Worcester.
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