V.V. Grubnik, Prof, O.I. Tkachenko, O.L. Kovalchuk. Odessa State Medical University
Background. The majority of surgeons in East European countries prefer to perform open procedures in patients with choledocholithiasis.
The aim of this study was to analyze safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open.
Methods: Prospective randomized trial was conducted from 2005 to 2009. 256 patients with CBD stones were operated. Laparoscopic CBD exploration was performed in 138 patients (group I), open procures was done in 118 patients (group II). Mean age was 62,3±5,8 years (61,4±5,2 years in group I and 63,1±6,4 years in group II).
In group I, laparoscopic ?BD trans-cystic exploration was successfully performed in 76 patients; laparoscopic choledochotomy was performed in 62 patients. External drain was used in 59 patients. No drain was used in 79 patients. Postoperative ERSP and stone extraction was required in 8 (5,8%) patients.
Laparotomy, open choledochotomy with T-tube placement was performed in 118 patients of group II.
Results. No mortality occurred. Mean duration of laparoscopic procedures was 82 min (range 40 to 160 min), mean duration of open surgery was 90 min (range 60 to 150 min) (p>0,1). Mean blood loss was 20 ml for the group I and 285 ml for group II (p<0,01).
Laparoscopic CBD clearance was successful in 94,2 % of patients. Conversion to open procedures was done in 2 (1,4%) cases. Postoperative complications were observed in 7 (5%) patients with subsequent reoperation, who underwent laparoscopic drainage of infrahepatic abscess and suturing of bleeding vessels of CBD. Two bile leaks with retained CBD stones was treated successfully by ERSP and biliary stenting. Another two patients with infrahepatic abcess formation were treated by percutaneous approach. One wound infection was drained without anesthesia. Nonsurgical site complications (1 case of urinary tract infection and 1 case of pneumonia) developed in 2 patients. Thus, morbidity in group I was 6,5 %.
In group II, 3 patients underwent reoperation due to dislocation of drainage in 2 patients, and progressive peritonitis in 1 patient. Morbidity in this group was 15 of 118 (12,7%). Wound infection and abscess formation was the main reason of complications. Mean postoperative stay was 4,2±1,8 days for group I and 12,6±4,5 days for group II (p<0,01).
Conclusions. Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and without mortality. Laparoscopic procedures has advances over open ones.
Program Number: S104