Laparoscopic common bile duct exploration through a choledochotomy for the management of choledocholithiasis
Keywords:
Laparoscopic surgery, choledocholithiasisAbstract
In the era of minimally invasive surgery, there are several options in the management of choledocholithiasis. Endoscopic sphincterotomy combined with laparoscopic cholecystectomy is an effective regimen, but requires 2 separate procedures. Laparoscopic common bile duct (CBD) exploration treats both the gallstones and CBD stones in a single operation, but greater laparoscopic skills are required.
The authors reported 29 consecutive patients who underwent elective or semielective laparoscopic CBD exploration through a choledochotomy over a 2.5 year-period. The operative technique was described. Two patients (7 per cent) had to be converted to an open operation. The median operative time was 210 minutes (135-380 minutes). There were no mortalities. Retained stones in the CBD occurred in 3 of the first 5 patients and in 1 of the last 24 patients. The patients were discharged on a median of 6 days (3-21 days) after operation.
As an increasing number of surgeons are acquiring skills in advanced laparoscopic techniques, laparoscopic CBD exploration has the potential of becoming the standard treatment for choledocholithiasis. Laparoscopic choledochotomy will probably be more suitable for the majority of Thai and Asian patients than the transcystic duct approach since the CBD stones are usually large and multiple and the CBD dilated. However, other therapeutic options must also be considered for each individual patient so that the safest and most efficacious treatment can be given.
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