title: Laparoscopic common bile duct exploration. Lessons learned after 200 cases.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure.
  
  
  OBJECTIVE
  To present our experience and the lessons learned in more than 200 cases of LCBDE.
  
  
  METHODS
  Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure.
  
  
  RESULTS
  The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity.
  
  
  CONCLUSIONS
  Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. Electronic address: israelabellanmorcillo@gmail.com.
authors.forename: Israel
authors.initials: I
authors.lastname: Abellán Morcillo
authors.affiliation: Department of Surgery, Ealing Hospital, Londres, Reino Unido; FRCS (fellowship of the Royal College of Surgeons).
authors.forename: Kamran
authors.initials: K
authors.lastname: Qurashi
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Abrisqueta Carrión
authors.affiliation: Department of Surgery, St. Mark's - Northwick Park hospital, Londres, Reino Unido; FRCS (fellowship of the Royal College of Surgeons).
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez Isla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D042883:Choledocholithiasis / Q000473:pathology* / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult
keywords: Choledocholithiasis; Cierre primario; Coledocolitiasis; Laparoscopia; Laparoscopy; Primary closure; Stent; T-tube; Tubo de Kehr