Krishna Asuri, MS, Bansal Virinder, MS, Misra Mahesh, MS. all india institute of medical sciences
Introduction: The optimum management of patients with concomitant gall stones and common bile duct (CBD) stones is debatable. ERCP followed by cholecystectomy is the preferred method of management at present. Although randomized trials have shown single stage cholecystectomy and laparoscopic CBD exploration to be equally efficacious and safe when compared with two stage endoscopic stone clearance followed by cholecystectomy. We hereby describe our experience of laparoscopic CBD exploration of more than 250 cases
Methods: Patients undergoing laparoscopic CBD exploration in a single surgical unit were studied prospectively at a tertiary care hospital from January 2006 to August 2016. Demographic details like age, sex, clinical features, cholangitis, acute pancreatitis, history of cholecystectomy and comorbidities was noted. Complete hemogram, liver function tests and prothrombin time were done. Findings of transabdominal ultrasound and ERCP were noted. An ERCP or magnetic resonance cholangiopancreatography (MRCP) was used for confirming the diagnosis of CBD stones and delineating biliary anatomy preoperatively in all patients. Reasons for failure of ERCP were noted. Intraoperative details like degree of adhesions, size of choledochotomy, number and size of stones, techniques used for stone extraction, mode of closure of bile duct, and level of difficulty of CBD exploration were noted. The postoperative recovery, complications,antibiotic usage, drain removal, and hospital stay were recorded.
Results: A total of 294 laparoscopic CBD explorations were performed during this period. Of these 64% were following ERCP failure. The total operative time was 110-230 minutes (average 135 minutes). The conversion rate was 12%. Majority of the patients had multiple stones. All patients underwent CBD exploration via a supradeudonal Choledochotomy except one where stone removal was done transcystically. The average stone size was 1.1 cm.Primary closure was done in 72% cases. A endobillliary stent was placed in 25% cases. Transient bile leak was seen in 28% cases which resolved without any intervention. Overall success rate of laparoscopic CBD exploration was 88%.
Conclusions: In centers where expertise in laparoscopic surgery is available with the required operative set up, primary Laparoscopic CBD exploration should be considered for treatment for patients with uncomplicated gallstones with common bile duct stones especially for patients with large and multiple stones.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80010
Program Number: S001
Presentation Session: Biliary
Presentation Type: Podium