Stone clearance and risk factors for failure in laparoscopic transcystic exploration of the common bile duct

• Published in: Surgical endoscopy Vol. 22; no. 5; pp. 1194 - 1199
• Main Authors: Strömberg, Cecilia, Nilsson, Magnus, Leijonmarck, Carl-Eric
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.05.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Bile ducts; Biliary Tract Surgical Procedures - methods; Biological and medical sciences; Cholangiography; Cholecystectomy; Choledocholithiasis - diagnostic imaging; Choledocholithiasis - surgery; Common Bile Duct - diagnostic imaging; Common Bile Duct - pathology; Common Bile Duct - surgery; Digestive system. Abdomen; Endoscopy; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Glucagon; Gynecology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - methods; Length of Stay; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Other diseases. Semiology; Patients; Proctology; Prospective Studies; Risk Factors; Surgery; Treatment Failure; United States > US; Sweden; Germany; Common bile duct stones; Transcystic technique; Laparoscopic common bile duct exploration; Endoscopic surgery; Choledocolithiasis; Laparoscopy; Clearance; Biliary tract disease; Medicine; Treatment; Risk factor; Digestive diseases; Endoscopy; Technique; Main biliary tract; Failure
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-007-9448-9

Background Laparoscopic cholecystectomy has become a gold standard globally. At the time of surgery, 5 to 10% of patients have coexisting stones in the common bile duct (CBD). There are several alternatives in treating these patients. We have chosen to try to extract the CBD stones at the primary operation by laparoscopic transcystic CBD exploration. Methods During the years 1994–2002 laparoscopic attempt of exploration of the CBD was made in 207 patients. Data was prospectively collected in a database, and was analyzed using unconditional logistic regression for risk factor analysis. Results In 155 of the 207 patients an attempt of transcystic CBD exploration was made and it was successful in 132 cases (85%). The median operating time was 184 minutes (range 89–384 minutes) and the median postoperative hospital stay was one day (range 1–31 days). The odds ratio for failure in stone clearance among patients with a bile duct diameter greater than 6 mm was 6.90 (95% confidence interval (CI): 0.87–54.61) compared to patients with a bile duct diameter of 6 mm or less. There was a significant threefold increase in risk among patients with stones of greater than 5 mm diameter compared to patients with stones 5 mm or less. Conclusions The laparoscopic transcystic exploration of the CBD had a high frequency of stone clearance and low morbidity in the present study. Moreover, large stones are a risk factor for failure in stone clearance.