Transcystic common bile duct exploration in the management of patients with choledocholithiasis |
| |
Authors: | Dr Sergio Rojas-Ortega MD Daniel Arizpe-Bravo MD Eduardo R Marýn López MD Rachid Cesin-Sánchez MD Gerardo Reed-San Roman MD Crispina Gómez |
| |
Institution: | (1) Department of Surgery and Gastroenterology, Hospital de la Sociedad Espanola, de Bene.cencia de Puebla, Puebla, Mexico;(2) Departamento de Cirugyá, Hospital de la Sociedad Espanola de Beneficencia de Puebla, 19 norte 1001 Col. Jesuś Garcyà, CP:72090 Puebla, Pue, México |
| |
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.
Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California,
May 19–22, 2002 (poster presentation). |
| |
Keywords: | Common bile duct stones laparoscopic transcystic bile duct exploration |
本文献已被 SpringerLink 等数据库收录! |
|