Preliminary experience with laparoscopic common bile duct exploration

Asaad F Salama 1 2, Mohamed E Abd Ellatif 3 4, Hesham Abd Elaziz 1, Alaa Magdy 5, Hisham Rizk 1 6, Magdy Basheer 5, Wisam Jamal 1 6, Ibrahim Dawoud 5, Ayman El Nakeeb 7

Affiliations

31 March 2017

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doi: 10.1186/s12893-017-0225-y

Abstract

Background: Herein we present our experience with laparoscopic common bile duct exploration (LCBDE) in managing common bile duct stones.

Methods: Data of 129 consecutive patients who underwent laparoscopic cholecystectomy (LC) and LCBDE done at our institutes from April 2011 through June 2016 were prospectively recorded and retrospectively reviewed.

Results: Since 2011, 3012 laparoscopic cholecystectomy were performed at our institutes, intraoperative cholangiogram (IOC) was done in 295 (9.8%) patients which detected choledocholithiasis in 129 (4.3%) of them. LCBDE was successful to clear the common bile duct (CBD) in 123/129 (95.4%). Six patients underwent postoperative endoscopic retrograde cholangiopancreatography (ERCP) because of incomplete CBD clearance (4 cases), symptomatic stenosed papilla (2 cases). LCBDE was performed in 103 patients via trans-cystic approach and choledochotomy one in 26 patients. In the choledochotomy group, seven patients had primary closure of the CBD, CBD was closed over T-tube in nine patients whereas the remaining 10 patients the CBD was closed over antegrade inserted stent. The median time of hospital stay was 4 (range; 1-15) days. No patients showed retained CBD stones with mean follow up was 9 ± 3.4 months.

Conclusion: LCBDE is a safe and cost effective option for CBD stones in short-term outcome and can be performed provided proper laparoscopic expertise and facilities are available.

Keywords: Choledocholithiasis; Cholelithiasis; Laparoscopic.

Figures

Fig. 1 intraoperative cholangiogram showing a filling defect that prevents passage of contrast into the duodenum

Fig. 1 intraoperative cholangiogram showing a filling defect that prevents passage of contrast into the duodenum

Fig. 2 Trans-cystic stone extraction by Dormia basket

Fig. 2 Trans-cystic stone extraction by Dormia basket

Fig. 3 Choledocotomy technique and extraction of big CBD stone

Fig. 3 Choledocotomy technique and extraction of big CBD stone

Fig. 4 Intraoperative trans-cystic Choledocoscope

Fig. 4 Intraoperative trans-cystic Choledocoscope

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