Management of impacted common bile duct stones during a laparoscopic procedure: A Retrospective Cohort Study of 377 Consecutive Patients.
BACKGROUND
To explore the techniques for managing impacted common bile duct (CBD) stones during laparoscopic common bile duct exploration (LCBDE).


METHODS
We retrospectively analyzed 377 consecutive patients undergoing LCBDE from January 2008 to June 2015. Group 1 was defined as patients with impacted CBD stones. Group 2 included patients without impacted CBD stones. The outcomes of LCBDE were compared between the two groups.


RESULTS
There were 65 patients in Group 1 and 312 patients in Group 2. The incidence of jaundice, abnormal liver function tests, cholangitis and pancreatitis was higher in Group 1. Forty-one patients with small impacted CBD stones were managed using the tipless Nitinol basket. Seventeen patients with large impacted CBD stones and 7 patients with small impacted CBD stones underwent laser lithotripsy via choledochoscopy. None of the patients in Group 1 was converted to open procedures for impacted CBD stones. Operation duration was 13.6 min longer in Group 1 (133.2 min). Postoperative hospital stay was significantly longer in Group 1 (9.7 ± 2.5 d) than in Group 2 (6.3 ± 1.8 d). There was no difference in the overall postoperative complication rate, retained stone rate, and recurrence rate between the two groups.


CONCLUSIONS
Rational utilization of laser lithotripsy and an appropriate basket in LCBDE may avoid conversion to open procedures in patients with impacted CBD stones.
Department of Hepatobiliary Surgery, Taizhou People's Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China. Electronic address: xkfy1979@126.com.
Zang
Z
Jinfeng
Department of Hepatobiliary Surgery, Taizhou People's Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China. Electronic address: 61736144@qq.com.
Yuan
Y
Yin
Department of Hepatobiliary Surgery, Taizhou People's Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China. Electronic address: zhcsir2000@sina.com.
Zhang
Z
Chi
Department of Hepatobiliary Surgery, Taizhou People's Hospital, The Fifth Affiliated Hospital of Medical School of Nantong University, Taizhou 225300, Jiangsu Province, China. Electronic address: gjy1215@tom.com.
Gao
G
Junye
D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002761:Cholangitis / Q000453:epidemiology / Q000209:etiology; D042883:Choledocholithiasis / Q000473:pathology / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007902:Length of Stay; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
Choledocholithiasis; Conversion; Laparoscopic surgery