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Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at a district general hospital

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Abstract

Background

The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt.

Methods

We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes.

Results

We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture.

Conclusion

Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients.

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Authors and Affiliations

  1. Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport, NP20 2UB, UK

    Mahmoud Al-Ardah, Simon Morris, Michael Nutt, Tamsin Boyce & Ashraf Rasheed

  2. Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

    Rebecca E. Barnett & Tarig Abdelrahman

Authors
  1. Mahmoud Al-Ardah
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  2. Rebecca E. Barnett
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  3. Simon Morris
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  4. Tarig Abdelrahman
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  5. Michael Nutt
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  6. Tamsin Boyce
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  7. Ashraf Rasheed
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Correspondence to Mahmoud Al-Ardah.

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Disclosures

Mahmoud Al-Ardah, Rebecca E. Barnett, Simon Morris, Tarig Abdelrahman, Michael Nutt, Tamsin Boyce, Ashraf Rasheed authors contributed substantially to the design/acquisition/analysis/interpretation of the work and were involved in drafting/revising the manuscript with approval of the final version and agreement to be accountable for the work. They were invited for presentation at DDW, May 2020, Chicago. No grant support was received. Mahmoud Al-Ardah, Rebecca E. Barnett, Simon Morris, Tarig Abdelrahman, Michael Nutt, Tamsin Boyce, Ashraf Rasheed have no conflicts of interest or financial ties to disclose.

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Al-Ardah, M., Barnett, R.E., Morris, S. et al. Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at a district general hospital. Surg Endosc 35, 6268–6277 (2021). https://doi.org/10.1007/s00464-020-08127-w

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  • DOI: https://doi.org/10.1007/s00464-020-08127-w

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