Laparoscopic management of common bile duct stones.
BACKGROUND
While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of common bile duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open common bile duct surgery, management of common bile duct stones can be conducted by laparoscopy, if respective experience is available.


METHODS
During laparoscopic cholecystectomy a cholangiography via the cystic duct is routinely performed. If bile duct stones are detected they are retrieved via the cystic duct or via incision of the common bile duct by insertion of a Fogarty catheter or Dormia basket. Exclusion criteria against simultaneous laparoscopic management include suspicion of malignancy, severe pancreatitis, or cholangitis.


RESULTS
From November 1991 to March 2002, 200 patients primarily underwent laparoscopic therapy of bile duct stones. Retrieval was performed via cystic duct and common bile duct incision in 115 and 85 cases, respectively. Complete removal was achieved in 91%; complication rate and mortality was 7% and 0.5%, respectively. During the same period primary endoscopic papillotomy was necessary in 40 patients because of the above contraindications.


CONCLUSIONS
When correct indications and surgical expertise are observed, simultaneous laparoscopic management of common bile duct stones represents a safe and minimally invasive alternative to a two-procedure approach.
Ebner
S
S
Department of General Surgery, General Hospital Bregenz, C.-Pedenz-Str. 2, 6900 Bregenz, Austria. stefan.ebner@lkhb.at
Rechner
J
J
Beller
S
S
Erhart
K
K
Riegler
F M
FM
Szinicz
G
G
D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic; D041761:Cholecystolithiasis / Q000150:complications / Q000601:surgery; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D011183:Postoperative Complications