Evaluation of laparoscopic management of common bile duct stones in 220 patients.
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.
Berthou
J C
JC
Clinique Chirurgicale Mutualiste, Lorient, France.
Drouard
F
F
Charbonneau
P
P
Moussalier
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome