Laparoscopic Common Bile Duct Exploration

Abstract

Since the introduction of laparoscopic cholecystectomy, the management of common bile duct (CBD) stones has undergone significant change. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is now routinely done in cases where the diagnosis of choledocholithiasis is suspected preoperatively, with clearance of the bile ducts before laparoscopic cholecystectomy. Intraoperative discovery of CBD stones by cholangiography represents a challenge to the surgeon, who must make a decision about when to perform laparoscopic CBD exploration, convert to open surgery, or send the patient for ERCP during the postoperative period. Because ERCP has a definite failure rate, laparoscopic CBD exploration can be a treatment option. Among 2500 laparoscopic cholecystectomies done by our group from January 1991 to June 1997, 50 patients (2%) underwent laparoscopic CBD exploration, 13 by the transcystic technique and 37 by choledocotomy, with a conversion rate of 8% and a hospital stay of 4.3 days. One patient died from complicated pancreatitis following ERCP and unsuccessful extraction of a CBD stone. We obtained our goal of a CBD free of stones in 92% of the cases. We conclude that laparoscopic CBD exploration is an effective method for treating choledocolithiasis that allows management of this pathology in one stage, although it requires advanced laparoscopic skills and adequate equipment.

Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study

“…The clearance rate for CBDS in the present study was 100 % in both the groups which is one of the best reported in the literature [11,26,31,47,48]. This has been possible due to the meticulous attention to detail paid by the authors in checking residual stones in the CBD using IOC or check choledochoscopy, as the case may be, in all the patients.…”

Laparoscopic common bile duct exploration

“…LCBDE has been performed in 2-12.1% of laparoscopic cholecystectomies [4,33,35,38,42,45]. The most common laparoscopic approach (Table 1) for common bile duct exploration has been the transcystic, and in 24 of the 31 reported series, the laparoscopic transcystic approach was the preferred method.…”

Laparoscopic management of CBD stones: an Indian experience

“…For ERCP ± ES, the stone clearance rates are 65-75% after one session and increase to 85-92.5% after three sessions [12]. The success rates decrease in patients with altered anatomy, such as intradiverticular papilla, abnormal localization of papilla, retropancreatic stenosis of bile duct, Billroth II bypass, and Mirizzi syndrome [23,24]. ERCP ± ES has a morbidity of 7.6-13.5% and includes the risk of pancreatitis, bleeding, perforation, cholangitis, delayed stricture of sphincter, residual/recurrent stones, papillary stenosis, and mortality of 0.4-0.55% [14,16].…”