Abstract
Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis of choledocholithiasis is made at the preoperative workup, it is common practice to refer the patient for endoscopic retrograde cholangiography and endoscopic sphincterotomy. However, if the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma-that is, the choice between laparoscopic common bile duct exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy. We have opted to treat patients with choledocholithiasis in only one session during the laparoscopic cholecystectomy; we use the transcystic common bile duct exploration technique employing the choledochoscope. We report our early experience in terms of success of stone removal, operative time, morbidity and mortality, and length of hospital stay. From 1992 to 2002, we performed 350 laparoscopic cholecystectomies. Selective cholangiography was used in 105 patients (30%); 40 of them were found to have common bile duct stones, for an incidence of 11.4%. Among this group, we performed laparoscopic transcystic common bile duct exploration in all but six patients. Our success rate for stone removal was 94.1% (32 of 34 patients), with only two failures related to multiple stones and impaction at the ampulla, for a conversion rate of 5.8%. The mean operative time was 120 ± 40 minutes. The morbidity rate was 8.8%, and there were no deaths. Length of hospital stay was 24 to 48 hours. Mean recovery time was 7 days, and time to return to work was 15±3 days. We concluded that most of the patients with common bile duct stones found during laparoscopic cholecystectomy could be treated successfully by means of the transcystic technique with choledochoscopy, with no increase in morbidity or mortality and a shortened hospital stay and recovery time, similar to patients who undergo only laparoscopic cholecystectomy. On the basis of our results, we recommend that this method become the primary strategy in the great majority of patients with common bile duct stones found during intraoperative cholangiography.
Similar content being viewed by others
References
Southern Surgeon’s Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991;324:1073–1078.
Tham TCK, Lichtenstein DR, Vandervoort J, et al. Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Gastrointest Endosc 1998;47:50–56.
Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335:909–918.
Petelin J. Laparoscopic approach to common bile duct pathology. Surg Laparosc Endosc 1991;1:33–41.
Phillips EH, Carroll BJ, Pearlstein AR, et al. Laparoscopic choledochoscopy and extraction of common bile duct stones. World J Surg 1993;17:22–28.
Phillips EH, Rosenthal RJ, Carroll BJ, Fallas MJ. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 1994;1:389–1394.
Hunter JG, Soper NJ. Laparoscopic management of bile duct stones. Surg Clin North Am 1992;72:1077–1097.
Hunter JG. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992;163:53–56.
Neuhaus H, Feussner H, Ungeheuer A, et al. Prospective evaluation of the use of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy. Endoscopy 1992; 24:745–749.
Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992;26:582–586.
Neoptolemos JP, Carr-Locke DL, London NJ, et al. Controlled trial of urgent endoscopic retrograde cholangiopancreatography endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1988;2:979–983.
Fan ST, Lai EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993;328:228–232.
Freeman M, Nelson D, Sherman S, Harmon M, Haber G, Moore J, Dorsher P, Mackie R, Rvyn M, Jamidar P, Shaw M, Silverman W, Cunningham J, Man K, Silvis S, Yakshe P, Fennert M, Di Sario J, Lo S, Logan G, Pheley A. Complications of endoscopic sphincterotomy (ES): A prospective multicenter 30-day outcome study. The Hennepin County Medical Center, Minneapolis, MN and the MESH Study Group. Abstract Presented at the World Congress of Gastroenterology, Los Angeles, California, October 2–7, 1994.
Rojas S, De la Garza L, Campuzano M. Es.nteroplastia transduodenal. Rev Gastroenterol Mex 1991;56:7–12.
Rhodes M, Sussman L, Cohen L, Lewis MP. Randomized trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 1998;351:159–161.
Dion YM, Ratelle R, Morin J, Gravel D. Common bile duct exploration: The place of laparoscopic choledochotomy. Surg Laparosc Endosc 1994;4:419–424.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rojas-Ortega, S., Arizpe-Bravo, D., López, E.R.M. et al. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg 7, 492–496 (2003). https://doi.org/10.1016/S1091-255X(03)00026-X
Published:
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(03)00026-X