P Senthilnathan, R Parthasarathi, S Rajapandian, Anand Vijay, V P Nalankilli, C Palanivelu. GEM Hospital & Research Centre
Background/Rationale: Conventionally, removal of common bile duct stones (CBDS) by endoscopic retrograde cholangiopancreaticography (ERCP) is the standard of care. In failed ERCP due to multiple large CBD calculi or inaccessibility, Laparoscopic common bile duct exploration(LCBDE) is an established option for treating CBDS. The aim is to look at the feasibility of LCBDE and choledochoduodenostomy as a salvage procedure after failed endoscopic bile duct stone extraction, complicated bile duct stones and primary CBD strictures and to examine the short term outcomes of our laparoscopic choledochoduodenostomy series.
Method: We retrospectively reviewed a prospective database, to study the feasibility of LCBDE with choledochoduodenostomy as salvage procedure for failed ERCP and complicated bile duct stones
Result: In our Institution from period of Jan 2013 to October 2015, total number of ERCP done for CBD stones was (n1)=519 out of which failed ERCP account to (n2)=26.
26 patients who failed endoscopic stone extraction due to multiple large CBD calculi( 13), recurrent stones(5), lower CBD stricture(4), impacted primary CBD stone(3), periampullary diverticulum(1). These patients underwent LCBDE and choledochoduodenostomy and achieved successful stone clearance. Average operating time was 135 minutes and average blood loss was 55 ml. Stone clearance was done using direct choledochotomy in 13 patients, Dormia basket was used in 7 patients and balloon extraction was done in 6 patients. Stone clearance was confirmed with either choledochoscope or intraoperative cholangiogram in all patients. One patient developed bile leak which resolved spontaneously. The median length of stay for these 24 patients was five days.
Conclusion: Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be safe and effective method for treating complex CBDS with failed ERCP procedures, with added bonus of a short hospital stay and early recovery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80841
Program Number: P099
Presentation Session: Poster (Non CME)
Presentation Type: Poster
