Morris E Franklin Jr., MD, FACS, Miguel A Hernandez, MD, Jeffrey L Glass, MD, FACS, Matthew Brown, MD, Jaime Diaz, MD. Texas Endosurgery Institute
Routine use of intraoperative cholangiogram (IOC) in laparoscopic cholecystectomy leads to identification of patients with choledocholitiasis. Traditionally a surgical team performed its management, but the advance in technology of endoscopic retrograde cholangio-pancreatography (ERCP) introduces two teams, the gastroenterologist and surgical team, resulted 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 feasibly and safe.
Material and methods: A retrospective consecutive series of patients underwent laparoscopic CBDE between April 1991 and August 2016 at the Texas Endosurgery Institute were identified in the database of all the patients with choledocholitiasis that underwent to laparoscopic cholecystectomy and transcholedocal bile duct exploration, and were included in this study and the data was analyzed prospectively.
Results: Since January 1991 thru August 2016, 8591 patients were undergone to laparoscopic cholecystectomy with IOC. 626 (7.2%) were diagnosed with choledocholitiasis, 400 (64%) patients were women, and 226 (36%) were man. 476 (76%) were transcholedocal bile duct exploration with 457 (96%) T-tube placement. 150 (24%) were successful laparoscopic common bile duct 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, 27 (4.3%) patients had leak on the site of T-tube placement, 11 (1.7%) were underwent to re-exploration, and 5 (0.8) patients had T- tube complications.
Conclusions: Laparoscopic CBDE is a safe technique that allows the surgeon a successful exploration of the common bile duct and clearance of the stones. Two handed laparoscopic suturing techniques are essential, and a systematic stepwise technique is advised as well.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79485
Program Number: S002
Presentation Session: Biliary
Presentation Type: Podium