Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results

BACKGROUND: The aim of this prospective study was the evaluation of the laparoscopic treatment of common bile duct stones (CBDS) and its indications. METHODS: Five hundred five patients who underwent laparoscopic treatment of CBDS from October 1990 to September 2006 were included in the prospective study. The mean age of the patients was 63 years (range = 19-93). Four hundred fifteen patients were classified ASA I and ASA II and 90 were ASA III and ASA IV. CBDS were suspected or diagnosed preoperatively in 373 patients (73.8%) and diagnosed at intraoperative cholangiography (IOC) in 132 patients (26.2%). A transcystic duct extraction (TCDE) was attempted in 254 patients (50.4%) and a primary choledochotomy in 251 patients (49.6%). Biliary drainage after choledochotomy was used in 148 cases (48.8%). RESULTS: TCDE was successful in 191 cases (75.2%).The 63 failures were managed by laparoscopic choledochotomy in 53 cases and by endoscopic sphincterotomy (ES) in 10 cases. A choledochotomy was thus performed in 304 patients and successful in 295 cases (97%). The nine failures were managed by six conversions to laparotomy (2%) and three postoperative ES. The overall success rate was 96.2%. The morbidity rate was 7.9% with 4.8% of local complications and 3.1% of general complications. The mortality rate was 1%. There were 14 residual stones (2.8%) that were managed by a second laparoscopy in two cases and by ES in 12 cases with four failures managed by laparotomy in one case and laparoscopy in three cases. CONCLUSION: Laparoscopic management of CBDS was effective in more than 96% of cases and particularly safe in ASA I and ASA II patients. It has the advantage over ES followed by laparoscopic cholecystectomy (LS) to be a one-stage procedure.