One-stage Laparoscopic Cholecistectomy and Cbd Exploration With Primary Closure

Gintaras Antanavicius, MD FACS, Carlos A Cutini Cingozoglu, MD, Patricio E Donnelly, MD, Rodolfo H Scaravonati, MD, Rodrigo Moran Azzi, MD, Roberto P Munin, MD, Victor H Serafini, MD FACS. Sanatorio Güemes, Argentina. Abington Health, USA


 Introduction: There are several approaches for choledocolithiasis and current data do not suggest clear superiority of any approach; decision regarding treatment is based on surgeons preferences, experience and equipment disponibility. When trancistic common bile duct (CBD) exploration fails, choledochotomy is an option. The open bile duct may be done with closure on a T-tube or primary closure.
We report the result for one-stage laparoscopic cholecistectomy and CBD exploration with primary closure.

Methods: Retrospective analysis from a prospectively collected database. We include all laparoscopic cholecistectomy with intraoperative finding of common bile duct stones.

Inclusion Criteria: Failure of trancistic exploration
                                 Dilated CBD
                                Complete ductal clearence after CBD exploration

Result: Between August 2007 and May 2011, we performed 8 laparoscopic cholecistectomy with CBD exploration and primary closure (1male,7 female). The average age was 46 years old (range 21-62 years).12,5% were elective procedures and 87,5% of patients were performed in the emergency settings. The presence of CBD stone was suspected preoperatively in 7 cases and in one case was an incidental finding. The rate of convertion was 12,5% (n=1). The operative time was about 153 min (range 105-225 minutes). None of the patients required post operative ERCP (Endoscopic Retrograde Cholangiopancreatography). In one case we performed an intraoperative choledocoscopy. The average post operative stay was 4 days (range 2-8 days). There was no mortality and the morbidity was 12,5% (Bilirragia that resumed in five days).

Conclusion: Laparoscopic common bile duct exploration with primary closure is safe and effective for selected patients. Future experience is needed for further study on the sistematic or elective use of choledocoscopy.


Session Number: Poster – Poster Presentations
Program Number: P387
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