title: Treatment of gallbladder stone with common bile duct stones in the laparoscopic era.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients.
  
  
  METHODS
  From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE. Intraoperative findings, postoperative complications, postoperative hospital stay and costs were analyzed.
  
  
  RESULTS
  Because of LCBDE failure,16 cases (4.6%) required open surgery. Of 330 successful LCBDE-treated patients, 237 underwent LTSE and 93 required LC. No mortality occurred in either group. The bile duct stone clearance rate was similar in both groups. Patients in the LTSE group were significantly younger and had fewer complications with smaller, fewer stones, shorter operative time and postoperative hospital stays, and lower costs, compared to those in the LC group. Compared with patients with T-tube insertion, patients in the LC group with primary closure had shorter operative time, shorter postoperative hospital stay, and lower costs.
  
  
  CONCLUSIONS
  In cases requiring LCBDE, LTSE should be the first choice, whereas LC may be restricted to large, multiple stones. LC with primary closure without external drainage of the CBDS is as effective and safe as the T-tube insertion approach.
authors.affiliation: Department of General Surgery, the Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. zhangweijie1616@163.com.|Department of General Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China. zhangweijie1616@163.com.
authors.forename: Wei-jie
authors.initials: WJ
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. guifangxu136@sina.com.
authors.forename: Gui-fang
authors.initials: GF
authors.lastname: Xu
authors.affiliation: Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, Massachusetts, 02132, USA. qinhuang0122@gmail.com.
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China. lkl197041@yahoo.com.
authors.forename: Kun-lun
authors.initials: KL
authors.lastname: Luo
authors.affiliation: Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China. dztdzt81@126.com.
authors.forename: Zhi-tao
authors.initials: ZT
authors.lastname: Dong
authors.affiliation: Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China. mycool166@sina.com.
authors.forename: Jie-ming
authors.initials: JM
authors.lastname: Li
authors.affiliation: Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China. wuguoz2011@126.com.
authors.forename: Guo-zhong
authors.initials: GZ
authors.lastname: Wu
authors.affiliation: Department of General Surgery, the Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. guan-wx@163.com.|Department of General Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China. guan-wx@163.com.
authors.forename: Wen-xian
authors.initials: WX
authors.lastname: Guan
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D042883:Choledocholithiasis / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics; D011446:Prospective Studies; D016896:Treatment Outcome