Is LCBDE a savior for failed endoscopic bile duct stone extraction

Bora Koc, MD, Servet Karahan, prof, Gokhan Tolga Adas, MD, Ayhan Ozsoy

Department of Surgery, Okmeydan? Training and Research Hospital

The ideal management of common bile duct stones remains controversial worldwide. Preoperative endoscopic retrograde cholangiopancreaticography (ERCP) is probably the most widely chosen option for the treatment of CBDS. Previous abdominal surgery especially Billroth II gastrectomy and the failure of cannulation and stone removal and also the morbidity associated with open surgery have paved the way for considering laparoscopic common bile duct exploration (LCBDE). The purpose of this study was to present our early experience, with special emphasis on the utility of LCBDE that ERCP was failed for the treatment of choledocholithiasis.

A total of 32 patients with CBDS, LCBDE were offered to those who failed ERCP from 2008 March to 2010 April were taken into analysis retrospectively in Okmeydan? Training and Research Hospital. In 32 patients, there was a failure of complete duct clearance with ERCP: in 12 patients (37.5%) because of Billroth II Gastrectomy, in 8 patients (25%) because of inability to cannulate the papilla (in 3 patients for the presence of duodenal diverticula), in 8 patients (25%) because of failure of stone removal and in 4 cases (12.5%) because of patient’s intolerance to the procedure.

The total time of the treatment of LCBDE was 115±38 minutes. Choledochoscopy was performed for all patients with transcholedochal route in an average time of 24±12 minutes. For all cases basket and balloon extraction of calculi was performed until complete clearance of CBD stones at the direct view. The CBDS could be extracted successfully for 31 patients.

In experienced hands, LCBDE is a safe and feasible option with the advantages of minimal access and preservation of sphincter anatomic functions.

Session: Poster Presentation

Program Number: P343

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