Laparoscopic CBD exploration; 15 years experience

Duncan Light, Yousef Aawsaj, Liam Horgan. Northumbria Healthcare NHS Foundation Trust

Background:  The treatment of common bile duct stones remains controversial with debate between endoscopic cholangiopancreatography (ERCP) and common bile duct exploration. A recent meta-analysis has shown no significant difference between these approaches, however there is a trend in the literature to favour a single stage procedure in the form of laparoscopic common bile duct exploration. We report our experience over a 15 year period.

Methods:  All cases of common bile duct exploration were identified from 2000 to 2015 and analysed retrospectively from a large NHS Foundation Trust in Northumbria. There were no exclusions.

Results:  296 patients were included who underwent laparoscopic common bile duct exploration. 203 were female and 93 were male. The mean age was 60 years (range 16 to 84 years). 231 procedures were performed electively and 65 as an emergency. 10 procedures were successfully performed as day cases. 11 procedures were converted to an open procedure due to adhesions or a difficult dissection (4%). 63 procedures were performed with a transcystic approach with a mean post op stay of 2 days (range 0 to 7). 233 procedures were performed with a choledocotomy with a mean post op stay of 6 days (range 3 to 14 days). Stone clearance was successful in 255 patients (86%). A subsequent ERCP was performed for the remaining 41 patients. 3 patients returned to theatre for early post operative bleeding (1%). 16 patients had persistent bile leaks following a choledocotomy (5%). 9 were managed conservatively, 4 patients were taken for a laparoscopy and 3 patients had an ERCP with a biliary stent placed. There was no significant difference between a continuous or interrupted closure of the choledocotomy. No patient developed recurrent stones on follow up.

Conclusion:  Laparoscopic bile duct exploration can be performed successfully in both the emergency and elective setting. Daycase surgery is feasible in selected patients. A transcystic approach should be favoured where possible.

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