Laparoscopic common bile duct exploration for choledocholithiasis: Theodor Bilharz Research Institute preliminary experience

Salama, Asaad F.; Helmy, Ahmed H.; Hedaya, Mohamed S.; Rizk, Hisham; Esmat, Emad

doi:10.4103/1110-1121.176812

Laparoscopic common bile duct exploration for choledocholithiasis: Theodor Bilharz Research Institute preliminary experience

Authors

Abstract

Background
Laparoscopic common bile duct stones exploration (LCBDE) is a potential option for the management of stones within the biliary tree at the same time as laparoscopic cholecystectomy.
Materials and methods
All data on LCBDE were prospectively collected from April 2014 to June 2015; 36 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. There were 10 men and 26 women, median age 57 years (range 43-71 years). Our inclusion criteria were as follows: patients with obstructive jaundice because of stones, patients who had not undergone upper abdominal surgery, surgically fit patients with concomitant gallstones and common bile duct (CBD) stones (de-novo cases), patients in whom endoscopic retrograde cholangiopancreatectomy retrieval had failed previously mainly because of instrumentation failure; large or multiple CBD stones requiring extraction and drainage with remaining stent; LCBDE that could be approached either through the cystic duct or directly through a choledochotomy incision.
Results
All patients survived the operation. Successful LCBDE and stone clearance were achieved in 34 of 36 patients, whereas treatment failure occurred in the other two patients. The reasons for failure were due to instruments issues e.g. balloon rupture and broken basket. No incidences of bile leakage, hemobilia, abdominal bleeding, or pancreatitis occurred in the patients in our series. Transient colic pain occurred in two patients and was treated conservatively. A transient increase in the liver function tests (aspartate aminotransferase and alanine aminotransferase) was observed in three patients and returned to normal on postoperative day 3 without any treatment. The external drainage tube was removed 48 h postoperatively.
Conclusion
LCBDE can be performed after proper training and with the availability of adequate equipment and laparoscopic facilities. LCBDE is a safe and cost-effective treatment option for gall bladder and CBD stones in the short term.

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