Choledochoscopy may not be necessary for Laparoscopic Common Bile Duct Exploration

Ahmed Elgeidie. gastroenterology surgical center, mansoura university

Background. Laparoscopic common bile duct exploration had been proved to be a safe, efficient and cost-effective option for management of common bile duct stones. There are two guiding methods during LCBDE; fluoroscopic or choledochoscopic guidance. Most surgeons prefer the use of flexible choledochoscopy at LCBDE but it is a fragile, delicate and expensive instrument. The aim of this work is to report our experience in fluoroscopically-guided LCBDE.

Methods. A retrospective review of all patients who underwent LCBDE in Mansoura Gastroenterology surgical center between March 2007 and September 2014 was performed. Patients with gallstones and concomitant CBD stones were included. After initial assessment, all patients fulfilling the criteria of enrollment underwent MRCP, and only patients with MRCP or ERCP evidence of CBD stones were included. Choledochoscopy was not used in any patient and we depended on fluoroscopic guidance for CBD stones retrieval in all LCBDE.

Results. A total of 346 patients were assessed for LCBDE. 79 patients were excluded. Ninteen patients were not completed laparoscopically due to negative intraoperative cholangiography (n = 15) and conversion to laparotomy (n = 4). The remaining 248 patients were analyzed. LCBDE failed in 17/248 (6.9%) with a success rate of 93.1%. The median operative time was 79 minutes, the median hospital stay was 2.4 days. Complications were bile leakage (n=5), mild pancreatitis (n=3), wound infection (n=2), port hernia (n=1), and internal hemorrhage (n=1)

Conclusions. Compared to published studies using choledochoscopy at LCBDE, we found comparable results in terms of success/failure rate, morbidity and mortality, operative time and length of hospital stay. LCBDE under fluoroscopic guidance may be as safe and as efficient as choledochoscopic guidance

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