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Laparoscopic management of common bile duct stones

Laparoscopic common bile duct exploration (CBDE) was the subject of a multi-institutional study on 226 patients from 19 major hospital centers. Female patients predominated (2.3:1); the average age was 54; 75% of cases were chronic, and the remainder were acute. Although 97% had preoperative ultrasonograms, only 12% showed a stone in the dilated common bile duct. The alkaline phosphatase was elevated in 41% and the serum bilirubin in 28% of cases. Preoperative endoscopic retrograde cholangiography with sphincterotomy (ERC-ES) was performed in 8.5%; there was a successful stone extraction in less than half the cases. Cholangiography was performed in 99.5%, and in 94% of those cases, stones were found.

In 83% of cases, stones were removed through the transcystic approach, and in 17% removal was throughout the CBD. In the majority of cases, the choledochoscope and wire basket (34%), irrigation (33%), or a combination of both was employed. In the transcystic group, 5% were converted to open procedures due to technical difficulty, as contrasted with the trans-CBD route, where the conversion rate was 19%. There were two ductal injuries. Minor complications occurred in 5.7% within 24 h; there was one death (0.4%). Within 30 days, the morbidity rate was 7% and there were no deaths. Retained stones were discovered in 2.6% of cases.

Laparoscopic CBDE is a feasible approach for CBD stones which permits a definitive procedure in one stage, without pre- or postoperative ES. It is a skill which should be mastered by the biliary surgeon. Further improvement in instrumentation and technique should make the laparoscopic approach not only comparable but preferable to the standard open choledocholithotomy.

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1. G. Berci

   Present address: Endocare Center, Midway Hospital, Medical Plaza, Suite 405, 5901 West Olympic Boulevard, 90036, Los Angeles, CA, USA

1. Division of General Surgery, Department of Surgery, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, 90048, Los Angeles, CA, USA

   G. Berci & L. Morgenstern

1. G. Berci
2. L. Morgenstern

Berci, G., Morgenstern, L. Laparoscopic management of common bile duct stones. Surg Endosc 8, 1168–1175 (1994). https://doi.org/10.1007/BF00591044

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• Received: 02 February 1994

• Accepted: 05 April 1994

• Issue Date: October 1994

• DOI: https://doi.org/10.1007/BF00591044

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