Evaluation of laparoscopic management of common bile duct stones in 220 patients |
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Authors: | J Ch Berthou F Drouard Ph Charbonneau K Moussalier |
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Institution: | (1) Clinique Chirurgicale Mutualiste, 3 Rue Robert de la Croix-56100, Lorient, France, FR;(2) Centre Hospitalier, 1 Avenue de l'Hospital, B.P. 608-02321 Saint-Quentin, France, FR |
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Abstract: | Background: The aim of this study was to evaluate the feasability and results of laparoscopic management of common bile duct stones (CBDS).
Methods: From October 1990 to November 1996, 220 patients with CBDS have been managed laparoscopically. CBDS were suspected or diagnosed
preoperatively in 130 patients (59.1%) and at intraoperative cholangiography (IOC) in 90 patients (40.9%). A transcystic duct
extraction (TCDE) was attempted in 112 patients and a primary choledochotomy in 108 patients.
Results: TCDE was successful in 77 cases (68.8%). The 35 failures were treated by 29 laparoscopic choledochotomies, 1 intraoperative
and 5 postoperative endoscopic sphincterotomies (ES). A choledochotomy was thus performed in 137 cases and was successful
in 133 cases (97.1%). The four failures were managed by three laparotomies and one postoperative ES. The overall success rate
was 95.5% (210/220). There was 4 deaths (0.9%) within the 1st postoperative month in ASA 3 patients and the morbidity rate was 9.1% (20/220). There were 7 residual stones (3.2%).
Conclusions: Laparoscopic desobstruction of CBDS appears to be safe and effective and has the advantage to be a single-stage procedure.
It could become in the future with refinement of instrumentation and skill of surgeons the best treatment for the majority
of patients harboring CBDS.
Received: 8 December 1996/Accepted: 14 February 1997 |
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Keywords: | : Common bile duct stones — Transcystic duct extraction — Laparoscopic choledochotomy — Choledochoscopy — Endoscopic sphincterotomy |
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