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An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland

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Abstract

Background and aim

To audit short- and long-term outcomes after laparoscopic common bile duct exploration (LCBDE) and factors influencing the success of the laparoscopic treatment.

Methods

From January 1999 to December 2011, 288 patients (93 males) underwent a single-stage laparoscopic cholecystectomy combined with LCBDE in two Finnish Hospitals. Short-term outcome data were collected prospectively. Long-term outcomes were examined retrospectively. The main measures of outcome were the success of laparoscopic CBD stone clearance and recurrence of CBD stones in the long-term, with 30-day mortality, morbidity, and the length of postoperative hospital stay as secondary outcome measures.

Results

CBD stones were successfully removed by one-stage laparoscopic procedure in 232 of the 279 patients (83.2 %) with verified CBD stones and after conversion to open surgery in additional 28 patients (93.2 %). Nineteen patients (6.8 %) having residual stones after surgery were successfully treated with postoperative ERCP. On multivariate analysis, the independent factors associated with a failed laparoscopic stone clearance were stone size over 7 mm [OR 3.51 (95 % CI 1.53–8.03), p = 0.003], difficult anatomy [OR 18.01 (5.03–64.49), p < 0.001] and transcholedochal approach [OR 2.98 (1.37–4.47), p = 0.006]. Laparoscopic stone clearance also failed in all 11 patients having impacted stones at the ampulla of Vater. Cumulative long-term recurrence rate was 3.6 % at 5 years and 6.0 % at 10 years. Thirty-day mortality was 0.3 % and morbidity 12.2 %. Postoperative hospital stay was median 2 (IQR 1–3) days after transcystic CBD removal and 4 (IQR 3–7) days after transcholedochal CBD removal, p < 0.001.

Conclusion

Our results show that one-stage LC combined with LCBDE stone clearance is safe and effective in most patients thus reducing the number of additional, potentially dangerous endoscopic procedures. Moreover, large or impacted stones are a risk factor for failed stone clearance.

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Disclosures

A Mattila, J Luhtala, J Mrena, I Kellokumpu and H Kautiainen have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Central Hospital of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland

    Anne Mattila, Johanna Mrena & Ilmo Kellokumpu

  2. Department of Surgery, Hyvinkää Hospital, Hospital District of Helsinki and Uusimaa, Sairaalankatu 1, 05850, Hyvinkää, Finland

    Jussi Luhtala

  3. Department of General Practice, Primary Health Care Unit, Turku University Hospital, 20520, Turku, Finland

    Hannu Kautiainen

  4. Department of Surgery, Unit of Primary Health Care, Helsinki University Hospital, 00029, Helsinki, Finland

    Hannu Kautiainen

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  1. Anne Mattila
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Correspondence to Ilmo Kellokumpu.

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Mattila, A., Luhtala, J., Mrena, J. et al. An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc 28, 3451–3457 (2014). https://doi.org/10.1007/s00464-014-3620-9

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