Paulina Bajonero Canónico, MD1, Morris Franklin jr, MD2, Miguel A Hernandez, MD2, Dolores Lopez-Garnica, MD1, Montserrat Guraieb-Trueba, MD1. 1Tecnologico de Monterrey, 2Texas Endosurgery Institute
Introduction: Routine use of intraoperative cholangiogram (IOC) in laparoscopic cholecystectomy leads to identification of patients with choledocholithiasis. Traditionally a surgical team performed its management, but advances in technology of endoscopic retrograde cholangiopancreatography (ERCP) introduces two teams, the gastroenterologist and surgical team, resulting in a costly way to solve this common problem. The aim of this paper is to demonstrate that the laparoscopic common bile duct exploration is feasible and safe.
Material and methods: A prospective developed of database of patients who underwent laparoscopic CBDE transcholedocal or transcystic between January 1991 and January 2017 at the Texas Endosurgery Institute were included in this study and the data was analyzed prospectively.
Results: Since January 1991 thru January 2017, 8934 patients underwent to laparoscopic cholecystectomy with IOC. 650 (7.27%) were diagnosed with choledocholithiasis, with 421 (64.7%) women, and 229 (35.3%) men. 498 (76.6%) were transcholedocal bile duct exploration with 483 (97%) T-tube placement. 152 (23.4%) were successful laparoscopic common bile duct exploration by transcystic technique. 4 (0.6%) patients had bleeding which was controlled with conservative treatment, 2 (0.3%) patient had jaundice, 6 (0.9%) patients had pancreatitis, 6 (0.9%) had wound infection, 4 (0.6%) patients had biloma, 2 (0.3%) patient had cholangitis, 11 (1.7%) patients had retained stones and needed ERCP, and 5 (0.8) patients had T- tube complications, 2 dislodged in recovery room, when nurses manipulated tube, 2 dislodged 2 days PO in patient’s room, 1 difficulty to remove.
Conclusions: Laparoscopic CBDE is a safe and feasible technique to treat choledocholithiasis either via common or cystic duct, allowing a successful exploration and clearance of the stones. Two-handed laparoscopic suturing techniques are essential, and a systematic stepwise technique is adviced.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88190
Program Number: S020
Presentation Session: Biliary Session
Presentation Type: Podium