Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones
- 459 Downloads
This study was designed to explore the role of transcystic bile duct exploration (TCE) as a first line of treatment for patients with suspected or incidental common bile duct (CBD) stones.
A prospective, case-control study of clinically comparable groups of patients who underwent laparoscopic cholecystectomy (LC) alone (n = 1,854) and combined LC/TCE for CBD stones (n = 253) under the care of one surgeon was performed. Other than ultrasonography, no routine preoperative imaging was used; however, we performed routine intraoperative cholangiography on all patients.
There was no difference in age (49 ± 15 vs. 57 ± 19, p = 0.7), sex (79% vs. 82% females, p = 0.6), and ASA grade (1.9 ± 1 vs. 1.8 ± 1, p = 0.7). A larger proportion of the TCE group presented as an emergency (TCE 45% vs. LC alone 27%, p = 0.03) and more often presented with acute biliary pain compared with LC alone (27% vs. 13%, p = 0.02). Although a majority of the patients in the TCE group had clinical or biochemical risk factors for CBD stones (86%), only 27% had suspected stones on preoperative ultrasound. The incidence of jaundice (6% vs. 20%, p = 0.01) was lower in the LC alone group compared with TCE patients. Previous abdominal surgery was noted in 34% patients who underwent LC alone and 30% in LC/TCE (p = 0.06). Significantly there was no difference in open conversion between the two groups (LC alone 0.5% vs. LC/TCE 0.6%, p = 0.07). Comparison of selected outcome parameters for LC versus TCE showed a postoperative hospital stay of 2 (1–14) vs. 2 (1–17) days (p = 0.07), presentation to resolution 1 (1–11) vs. 1 (1–11) weeks (p = 0.07), and morbidity 1.07% vs. 1.2% (p = 0.07).
The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones.
KeywordsLaparoscopic cholecystectomy Intraoperative cholangiogram Transcystic CBD exploration Choledochotomy
Drs. Faisal Hanif, Zubir Ahmed, Abdel M. Samie, and Ahmad Nassar have no conflicts of interest or financial ties to disclose.
- 6.Martin DJ, Toouli J (2001) Surgical versus endoscopic treatment of bile duct stones [review]. Cochrane Detabase Syst Rev 19(2):CD003327Google Scholar
- 19.Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(S2): S441–S445Google Scholar