Laparoscopic common bile duct exploration after failed endoscopic stone extraction.
BACKGROUND
Our objective was to present the technical aspects and results of laparoscopic common bile duct (CBD) exploration following failed endoscopic stone extraction.


METHODS
From April 1997 to December 2006, 32 patients were referred to us after unsuccessful attempts at endoscopic CBD stone extraction. Transcholedochal laparoscopic CBD exploration was used in all patients. Previous operations, several pathologic entities, and stone impaction were studied as potential predictors of failure of the laparoscopic approach.


RESULTS
Previous operations, cholangitis, anatomic abnormalities, and stone impaction were the principal reasons for failure of endoscopic retrograde cholangiopancreatography (ERCP). Stone extraction under direct laparoscopic choledochotomy was achieved in 20 of 31 patients (64.51%). Biliary stents were inserted in 7 patients (21.8%) and T tubes were placed in 21 patients (65.6%). Five laparoscopic choledochoduodenostomies were performed. There were 11 conversions to open surgery. Morbidity was 12.5%.


CONCLUSIONS
Laparoscopic choledochotomy is an efficacious procedure in dealing with unsuccessful endoscopic CBD clearance.
Karaliotas
Constantine
C
2nd Surgical Department of Korgialenion - Benakion, Red Cross Hospital, 11 Mantzarou str., Neo Psychiko, 15451, Athens, Greece.
Sgourakis
George
G
Goumas
Constantine
C
Papaioannou
Nickolaos
N
Lilis
Constantine
C
Leandros
Emmanouel
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome