Comparison of Laparoscopic Cbd Exploration,ercp and Open Choledocholithotomy for Large Cbd Calculi

CBD calculi is a common complication of cholelithiasis. ERCP and open choledocholithotomy are the two common procedures used to deal with this problem.
Laparoscopic choledocholithotomy is technically demanding procedure because it
requires fine endo suturing but at the same time more beneficial and result oriented than the other two methods. In this study laparoscopic CBD exploration was compared in length with other two methods.

We compared results in 247 patients under going laparoscopic choledocholithotomy, ERCP and open choledocholithotomy over 30 months period.
A retrospective comparative study was carried out in three methods. High definition endovision system with 2 cameras, a uretero reno scope 7 fr and a nephroscope 17 fr was used in addition to routine instruments in cases of lap CBD exploration.Larger stones were fragmented under vision in laparoscopic CBD exploration. Post exploration CBD was checked by cholangiogram or 7 fr ureterorenoscope. CBD was closed with stent in situ or T tube or closed primarily or was anastamosed with intestine.

Complications in the form of pancreatitis, wound infection, duodenal perforation, bile leakage, and residual stones were least in laparoscopic choledocholithotomy as compared to ERCP and open choledocholithotomy. The anatomy of CBD and rest of bile ducts ( R and L hepatic ducts) could be clearly delineated with 7 fr ureterorenoscope. This scope could almost always be negotiated through sphincter of oddi and duodenum could always be anticipated.

Single stage Laparoscopic choledocholithotomy should be the procedure of choice in choledocholithiasis especially in cases of large CBD calculi.

Session: Poster

Program Number: P392

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