Stone clearance and risk factors for failure in laparoscopic transcystic exploration of the common bile duct |
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Authors: | Cecilia Strömberg Magnus Nilsson Carl-Eric Leijonmarck |
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Institution: | Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden. cecilia.stromberg@karolinska.se |
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Abstract: | Background Laparoscopic cholecystectomy has become a gold standard globally. At the time of surgery, 5 to 10% of patients have coexisting
stones in the common bile duct (CBD). There are several alternatives in treating these patients. We have chosen to try to
extract the CBD stones at the primary operation by laparoscopic transcystic CBD exploration.
Methods During the years 1994–2002 laparoscopic attempt of exploration of the CBD was made in 207 patients. Data was prospectively
collected in a database, and was analyzed using unconditional logistic regression for risk factor analysis.
Results In 155 of the 207 patients an attempt of transcystic CBD exploration was made and it was successful in 132 cases (85%). The
median operating time was 184 minutes (range 89–384 minutes) and the median postoperative hospital stay was one day (range
1–31 days). The odds ratio for failure in stone clearance among patients with a bile duct diameter greater than 6 mm was 6.90
(95% confidence interval (CI): 0.87–54.61) compared to patients with a bile duct diameter of 6 mm or less. There was a significant
threefold increase in risk among patients with stones of greater than 5 mm diameter compared to patients with stones 5 mm
or less.
Conclusions The laparoscopic transcystic exploration of the CBD had a high frequency of stone clearance and low morbidity in the present
study. Moreover, large stones are a risk factor for failure in stone clearance. |
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Keywords: | Common bile duct stones Laparoscopic common bile duct exploration Transcystic technique |
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