Laparoscopic Common Bile Duct Exploration for the Treatment of Choledocholithiasis - Abstract
Background and aim: Choledocholithiasisis a prevalent complication in cholelithiasis and the laparoscopic treatment may be an alternative approach. Evaluate the results of the laparoscopic approach of choledocholithiasis in patients with cholelithiasis.
Methods: A total of 290 patients with cholelithiasis associated with choledocholithiasis, including 191 women (65.86%), with a mean age of 58.4 years (21-80), were treated. A transcystic approach was used in 46 cases (15.86%) and longitudinal choledochotomy in 244 (84.14%). Conversion to open surgery was necessary in 26 cases (8.96%).
Results: There was no case of death and the rate of early complications was 9.31% (27 cases). Thirteen patients (4.48%) had a biliary fistula demonstrated by cholangiography and all cases were treated clinically. Hyperamylasemia was detected in 11 cases (3.8%) and four patients (1.38%) had mild acute pancreatitis. All patients were treated clinically. Three cases (1.03%) developed choleperitoneum after removal of the bile duct catheter on postoperative day 21, and perforation of the posterior wall of the common bile duct was observed in one patient (0.34%). Late complications occurred in six cases (2.07%), including a residual stone in four (1.38%), which was treated by therapeutic endoscopy. Two cases (0.68%) developed bile duct stenosis; good resolution was observed in one after dilation and biliary stenting andrecurrence of stenosis occurred in the other case, which required a biliodigestive anastomosis consisting of interposition of a jejunal tube.
Conclusions: The results showed that treatment of choledocholithiasis in a single procedure through laparoscopic bile duct clearance is safe, reproducible and associated with a low rate of complications, in addition to preserving sphincter functions of the duodenal papilla.