Abstract
Laparoscopic common bile duct exploration (CBDE) was the subject of a multi-institutional study on 226 patients from 19 major hospital centers. Female patients predominated (2.3:1); the average age was 54; 75% of cases were chronic, and the remainder were acute. Although 97% had preoperative ultrasonograms, only 12% showed a stone in the dilated common bile duct. The alkaline phosphatase was elevated in 41% and the serum bilirubin in 28% of cases. Preoperative endoscopic retrograde cholangiography with sphincterotomy (ERC-ES) was performed in 8.5%; there was a successful stone extraction in less than half the cases. Cholangiography was performed in 99.5%, and in 94% of those cases, stones were found.
In 83% of cases, stones were removed through the transcystic approach, and in 17% removal was throughout the CBD. In the majority of cases, the choledochoscope and wire basket (34%), irrigation (33%), or a combination of both was employed. In the transcystic group, 5% were converted to open procedures due to technical difficulty, as contrasted with the trans-CBD route, where the conversion rate was 19%. There were two ductal injuries. Minor complications occurred in 5.7% within 24 h; there was one death (0.4%). Within 30 days, the morbidity rate was 7% and there were no deaths. Retained stones were discovered in 2.6% of cases.
Laparoscopic CBDE is a feasible approach for CBD stones which permits a definitive procedure in one stage, without pre- or postoperative ES. It is a skill which should be mastered by the biliary surgeon. Further improvement in instrumentation and technique should make the laparoscopic approach not only comparable but preferable to the standard open choledocholithotomy.
Similar content being viewed by others
References
Berci G, Phillips E, Sackier JM, Paz-Partlow M (1991) Routine or selective operative cholangiography during laparoscopic cholecystectomy. Am J Surg 161:335–360
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RCG, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy, complications and their management: an attempt at consensus. Gastroint. Endoscopy 37:383–393
Cuschieri A, Berci G (1992) Laparoscopic treatment of common duct stones. In: Cuschieri A, Berci G (eds) Laparoscopic biliary surgery, 2nd edition. Blackwell, Boston, pp 155–170
Fletcher D (1993) Laparoscopic cholecystectomy: role of pre- and postoperative ERCP and endoscopic sphincterotomy. In: Berci G (Ed) Gastrointestinal endoscopy clinics of North America. WB Saunders, Philadelphia, pp 249–259
Kozarek RA (1988) Balloon dilatation of the sphincter of Oddi. Endoscopy 20:207–210
Lambert ME, Betts CD, Hill J, Faragher EB, Martin DF, Tweedle DEF (1991) Endoscopic sphincterotomy: the whole truth. Br J Surg 78:473–476
Morgenstern L, Wong L, Berci G (1992) 1,200 open cholecystectomies before the laparoscopic era: a standard for comparison. Arch Surg 127:400–403
Morgenstern L, Berci G, Pasternak E (1992) Bile leakage after biliary tract surgery: a laparoscopic perspective. Surg Endosc 7:432–438
Pretlin JB (1991) Laparoscopic approach to common duct pathology. Surg Laparosc Endosc 1:33–41
Phillips E, Carroll BJ, Daykhovsky L, Fallas MG (1992) Laparoscopic choledochoscopy and extraction of common bile duct stones. World J Surg 17:22–28
Sackier JM, Berci G, Paz-Partlow M (1991) Laparoscopic transcystic choledocholithotomy as an adjunct to laparoscopic cholecystectomy. Am Surg 571:323–329
SAGES (1992) Guidelines for granting of privileges for laparoscopic (peritoneoscopic) general surgery. SAGES publication No. 0014
Shapiro SJ, Gordon LA, Daykhovsky L (1991) Laparoscopic exploration of the common bile duct: experience in 16 selected patients. J Laparosc Surg 6:333–341
Shimi S, Banting S, Cuschieri A (1992) Transcystic drainage after laparoscopic exploration of common bile duct. Min Invasion Ther 1:273–276
Stiegmann GV, Goff JS, Mansour A, Pearlman N, Reveille RM, Norton L (1992) Pre- cholecystectomy endoscopic cholangiography and stone removal is not superior to cholecystectomy, cholangiography and common duct exploration. Am J Surg 163:227–230
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Berci, G., Morgenstern, L. Laparoscopic management of common bile duct stones. Surg Endosc 8, 1168–1175 (1994). https://doi.org/10.1007/BF00591044
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00591044