Laparoscopic common bile duct exploration. Lessons learned after 200 cases

Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. To present our experience and the lessons learned in more than 200 cases of LCBDE. Between Januar...

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Bibliographic Details
Published inCirugia Española Vol. 92; no. 5; p. 341
Main Authors Abellán Morcillo, Israel, Qurashi, Kamran, Abrisqueta Carrión, Jesús, Martinez Isla, Alberto
Format Journal Article
LanguageEnglish
Spanish
Published Spain 01.05.2014
Subjects
Adolescent
Adult
Aged
Aged, 80 and over
Biliary Tract Surgical Procedures - methods
Choledocholithiasis - pathology
Choledocholithiasis - surgery
Common Bile Duct - pathology
Female
Humans
Laparoscopy
Male
Middle Aged
Retrospective Studies
Stents
Young Adult
Cierre primario
Coledocolitiasis
Choledocholithiasis
Laparoscopy
T-tube
Primary closure
Stent
Laparoscopia
Tubo de Kehr
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Summary:Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. To present our experience and the lessons learned in more than 200 cases of LCBDE. Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75.
ISSN:1578-147X
DOI:10.1016/j.ciresp.2013.02.010