Introduction : With the progress of gastrofiberscopy, the endoscopic sphincterotomy have been performed as a standard therapy for CBD stones. But in the recent studies, the primary laparoscopic CBD exploration is superior or not inferior than endoscopic sphincterotomy in the clearance rate and morbidity rate. And also, there have been many studies about the advantages of laparoscopic CBD exploration in hospital stay and the costs. The authors analyzed of the 79 patients undertaken laparoscopic CBD exploration and evaluated the clinical significance.
Patients and method : We retrospectively analyzed 79 patients undertaken laparoscopic CBD exploration at the department of surgery in Konyang university hospital between March 2001 and May 2008. All patients were in failure of endoscopic removal of stones or size of stones ¢®s 1cm or multiple CBD stones. The four port technique was performed in all patients. The stones were removed by 1~1.5cm sized incision in CBD, then we confirmed the remnant stone in CBD and intrahepatic duct (IHD) using choledochoscope. After the operation, we performed four biliary drainage method. Each of them was T-tube drainage, endobiliary stent, endoscopic nasobiliary drainage (ENBD) and percutaneous transhepatic biliary drainage (PTBD).
Results : Of the 79 patients, male were 36(45%) and female were 43 (55%) and mean age was 66 years (18~90). 29 cases (37%) were trying the endoscopic biliary stone removal before the operation. The mean operation time was 128 minutes. Patients had T-tube drainages (4 cases), internal biliary stent (21 cases), ENBD (18 cases) and PTBD (36 cases). On the average, the diet was started 2.5 days after the operation, and the mean length hospital day was 11 days (3~30). Convertion to the laparotomy was performed at 2 cases, one was because of the difficulty of complete removal of stones and the other one was because of bleeding by intrahepatic vessel injury (S5). At 6 of 21, endobiliary stent were not extracted spontaneously on follow-up simple abdomen X-ray at 4 weeks later, so endoscopic removal was performed for them. Patients with ENBD or PTBD discharged after removal of ENBD or PTBD and there was no mortality. There were 4 cases of complications, subhepatic seroma (2 cases) and bile leakage (2 cases). All of them with complication were recovered with conservative treatment. 1 case of all the 79 pateints was found the remnant stone 1 weeks later after the operation and the stone removed by endoscopic sphincterotomy. CBD stones were recurred in 3 cases of all the patient and removed by re-laparoscopic CBD exploration.
Conclusions : On the treatment of CBD stone, it is generally perfomed to laparoscopic cholecystectomy after CBD stone removal using endoscopy sphincterotomy. But it is need to choice treatement stratege considering hospital stay and the costs. And also, laparoscopic CBD exploration could be performed as the primary treatment in the poor cooperated patients, multiple CBD stones, large sized stones.
Program Number: P442