title: An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland.
abstract: OBJECTIVE
  To audit short- and long-term outcomes after laparoscopic common bile duct exploration (LCBDE) and factors influencing the success of the laparoscopic treatment.
  
  
  METHODS
  From January 1999 to December 2011, 288 patients (93 males) underwent a single-stage laparoscopic cholecystectomy combined with LCBDE in two Finnish Hospitals. Short-term outcome data were collected prospectively. Long-term outcomes were examined retrospectively. The main measures of outcome were the success of laparoscopic CBD stone clearance and recurrence of CBD stones in the long-term, with 30-day mortality, morbidity, and the length of postoperative hospital stay as secondary outcome measures.
  
  
  RESULTS
  CBD stones were successfully removed by one-stage laparoscopic procedure in 232 of the 279 patients (83.2%) with verified CBD stones and after conversion to open surgery in additional 28 patients (93.2%). Nineteen patients (6.8%) having residual stones after surgery were successfully treated with postoperative ERCP. On multivariate analysis, the independent factors associated with a failed laparoscopic stone clearance were stone size over 7 mm [OR 3.51 (95% CI 1.53-8.03), p = 0.003], difficult anatomy [OR 18.01 (5.03-64.49), p < 0.001] and transcholedochal approach [OR 2.98 (1.37-4.47), p = 0.006]. Laparoscopic stone clearance also failed in all 11 patients having impacted stones at the ampulla of Vater. Cumulative long-term recurrence rate was 3.6% at 5 years and 6.0 % at 10 years. Thirty-day mortality was 0.3% and morbidity 12.2%. Postoperative hospital stay was median 2 (IQR 1-3) days after transcystic CBD removal and 4 (IQR 3-7) days after transcholedochal CBD removal, p < 0.001.
  
  
  CONCLUSIONS
  Our results show that one-stage LC combined with LCBDE stone clearance is safe and effective in most patients thus reducing the number of additional, potentially dangerous endoscopic procedures. Moreover, large or impacted stones are a risk factor for failed stone clearance.
authors.affiliation: Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
authors.forename: Anne
authors.initials: A
authors.lastname: Mattila
authors.forename: Jussi
authors.initials: J
authors.lastname: Luhtala
authors.forename: Johanna
authors.initials: J
authors.lastname: Mrena
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Ilmo
authors.initials: I
authors.lastname: Kellokumpu
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D054869:Clinical Audit; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome