Background: Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. Methods: Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). Results: The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1–26). No patient required additional CBD procedures during follow-up. Conclusions: In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.
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Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. Author information Authors and AffiliationsDepartment of Visceral Surgery A, University Hospital Center Montpellier Hôpital Saint-Eloi, F-34295 Montpellier, France, France
G. Decker, F. Borie, B. Millat, F. Guillon & J.G. Rodier
Department of Surgery, Centre Hospitalier Lorient, F- Lorient, France, France
J.C. Berthou
Department of Surgery, Clinique Bonnefon, F-30100 Ales, France, France
A. Deleuze
Department of Surgery, Centre Hospitalier Saint-Quentin, F-02321 Saint-Quentin, France, France
F. Drouard
Department of Surgery, Centre Hospitalier Intercommunal, F-78303 Poissy, France, France
A. Fingerhut
Decker, G., Borie, F., Millat, B. et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc 17, 12–18 (2003). https://doi.org/10.1007/s00464-002-9012-6
Received: 15 January 2002
Accepted: 23 May 2002
Published: 01 January 2003
Issue Date: January 2003
DOI: https://doi.org/10.1007/s00464-002-9012-6
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