Introduction There is no clear consensus, from previous randomised controlled trials and meta-analyses, on the optimum treatment modality for common bile duct (CBD) stones. This study aimed to evaluate the single-stage laparoscopic approach to the management of CBD stones, as treatment of choice in patients who are fit for surgery, and to determine what results can be achieved when this treatment modality is chosen.
Methods The study was performed on a series of patients, both elective and emergency, who underwent laparoscopic CBD exploration, using prospectively collected data. Inclusion criteria were all patients who underwent laparoscopic CBD exploration (along with laparoscopic cholecystectomy) following a positive on-table intra-operative cholangiogram (performed selectively on patients with suspected CBD stones). The rate of successful CBD clearance was measured; markers of unsuccessful CBD clearance included finding of residual stones on T tube cholangiogram or MRCP, and the need for post-operative ERCP for clearance of either stones known to be left behind at the end of the procedure, or presenting symptomatically in the post-operative period. Morbidity was measured by identifying complications, including both intra-operative and post-operative, by case note review. Hospital stay was recorded from the date of admission to the date of discharge. Mortality was measured from hospital mortality audit records. Outcomes were noted in both elective and emergency situations. Finally a comparison of our experience was made with the recent published data.
Results In a series of 140 patients, successful clearance of CBD stones was achieved in 95.7% of cases. Retained stones were found in 3.6% cases and another 3.6% developed post-operative complications. A post-operative mortality rate of 1.4% was recorded, which was due to reasons not directly related to the procedure. The most common length of stay was 2 days, although the median length of stay was 4 days. 25% of cases were done as emergencies and 75% were elective. Overall conversion rate to open surgery was up to 12.8%, which mainly occurred in the emergency cases.
Conclusion Laparoscopic CBD exploration can be chosen as a safe and effective first line treatment for CBD stones; better results can be anticipated in elective (compared with emergency) patients.
Competing interests None declared.