Abstract
Background
Laparoscopic common bile duct (CBD) exploration is regarded as a safe, definitive procedure for ductal calculi, avoiding the complications of endoscopic retrograde cholangiopancreatography. We aimed to evaluate the outcomes of laparoscopic CBD exploration carried out by trainees compared to those of an experienced consultant (R.W.M.).
Methods
A prospective database of all cases of laparoscopic CBD exploration over a 15-year period was analyzed retrospectively. All patients underwent a four-port technique and intraoperative cholangiography. Patient demographics, operative technique, success, and complications were analyzed.
Results
The median age of patients undergoing laparoscopic CBD exploration was 65 years (range 14–94 years). In all, 187 (79%) of the CBD explorations were performed by one consultant and 48 (21%) by trainees. Calculi were successfully cleared in 141 (88%) and 43 (96%), respectively. There were two (<1%) conversions to an open procedure in the total group. The median operating time was 130 minutes in the consultant group versus 150 minutes in the trainee group (p < 0.05, Mann-Whitney U-test). There was no significant difference in CBD clearance rate, surgical approach, or complication rate between consultant and trainees (Fisher’s exact test).
Conclusions
Laparoscopic CBD exploration is a safe procedure in both consultant and trainee hands. With appropriate training, surgical trainees can achieve equivalent outcomes in CBD clearance with no significant difference in complication rates.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ko CW, Lee SP (2002) Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc 56:S165–S169
Lezoche E, Paganini AM, Carlei F et al (1996) Laparoscopic treatment of gallbladder and common bile duct stones: a prospective study. World J Surg 20:535–541
Fiore NF, Ledniczky G, Wiebke EA et al (1997) An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 122:817–821
Soltan HM, Kow L, Toouli J (2001) A simple scoring system for predicting bile duct stones in patients with cholelithiasis. J Gastrointest Surg 5:434–437
Collins C, Maguire D, Ireland A et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33
Metcalfe MS, Ong T, Bruening MH et al (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481
Rhodes M, Sussman L, Cohen L et al (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161
Cuschieri A, Lezoche E, Mornino M et al (1999) E.A.E.S. multicentre prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957
Sgourakis G, Karaliotas K (2002) Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis: a prospective randomised study. Minerva Chir 57:467–474
Nathanson LK, O’Rouke NA, Martin IJ et al (2005) Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomised trial. Ann Surg 242:188–192
Hong DF, Xin Y, Chen DW (2006) Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc 20:424–427
Clayton ES, Connor S, Alexakis N et al (2006) Meta-analysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 93:1185–1191
Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 19:CD003327
Andiriulli A, Loperfido S, Napolitano G et al (2007) Incidence rates of post- ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 102:1781–1788
Freeman ML, Nelson DB, Sherman S et al (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918
Cheng CL, Sherman S, Watkins JL et al (2006) Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol 101:139–147
Christoforidis E, Goulimaris I, Kanellos I et al (2002) Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy 34:286–292
Rojas-Ortega S, Arizpe-Bravo D, Marin Lopez ER et al (2003) Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg 7:492–496
Voitk AJ, Tsao SG, Ignatius S (2001) The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 182:250–253
Bresadola V, Intini S, Terrosu G et al (2001) Intraoperative cholangiography in laparoscopic cholecystectomy during residency in general surgery. Surg Endosc 15:812–815
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tutton, M.G., Pawa, N., Arulampalam, T.H.A. et al. Training Higher Surgical Trainees in Laparoscopic Common Bile Duct Exploration. World J Surg 34, 569–573 (2010). https://doi.org/10.1007/s00268-009-0335-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-009-0335-5