Is Laparoscopic Common Bile Duct Exploration Feasible without Choledochoscopy?

Ahmed A Elgeidie

gastroenterology surgical center, mansoura university

Background: Laparoscopic common bile duct exploration (LCBDE) had been proved to be a safe, efficient and cost-effective option for management of common bile duct (CBD) stones. In general, there are two guiding methods during LCBDE; fluoroscopic or choledochoscopic guidance. Most surgeons prefer the use of flexible choledochoscopy at LCBDE but flexible choledochoscopy is a fragile, delicate and expensive instrument. The aim of this work is to report our institution’s experience in fluoroscopically-guided LCBDE without the use of flexible choledochoscope in terms of success/failure rate, morbidity/mortality, operative time and length of hospital stay.

Materials and Methods: A retrospective review of all patients who underwent LCBDE in Gastroenterology surgical center, Mansoura University, Egypt between March 2007 and February 2012 was performed. Patients with gallstones and concomitant CBD stones as diagnosed by clinical presentation, lab studies, and abdominal US 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. Excluded from the study were patients with cholangitis or pancreatitis, postcholecystectomy patients, and patients with contraindication to laparoscopy. Choledochoscopy was not used in any patient and we depended on fluoroscopic guidance for CBD stones retrieval in all LCBDE.

Results: A total of 290 patients were assessed for LCBDE. 76 patients were excluded, 7 patients had negative IOC, and four patients were converted to laparotomy. The remaining 203 patients were analysis. LCBDE failed in 16/203 (7.8%) with a success rate of 92.2%. The median operative time was 79 (45-180) minutes, the median hospital stay was 2.4 (1-10) days and the incidence of retained stones was 2.4%. Other complications were bile leakage (n=4), mild pancreatitis (n=2), wound infection (n=2), port hernia (n=1), and internal hemorrhage (n=1).

Conclusion: Compared to published studies using choledochoscopy at LCBDE, we found a 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 and may be cost-effective as well. However, these conclusions should be verified by a prospective randomized study with a long term follow up on a large scale of patients.

Session: Podium Presentation

Program Number: S001

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