Laparoscopic common bile duct exploration: the past, the present, and the future

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Abstract

Background: The advent of laparoscopic cholecystectomy (LC) has created a dilemma for treating patients with known or suspected choledocholithiasis. With rapid technologic growth and experience in laparoscopic skills, many surgeons are now routinely performing laparoscopic common bile duct exploration (LCBDE) and questioning the wisdom of preoperative endoscopic retrograde cholangiography (ERC) with or without endoscopic sphincterotomy. The purpose of this article is to review the current literature on the subject of LCBDE and critically evaluate the clinical results of this emerging technology.

Methods: Medline and Science Citation Index databases were used to search English language articles published on LCBDE since 1989.

Results: Transcystic common bile duct exploration has a better clearance rate, and carries less morbidity and mortality compared with laparoscopic choledochotomy. Compared with two-stage ERCP and LC, one-stage LC and LCBDE seems to be associated with a shorter hospital stay, a quicker recovery, less expense, and less morbidity and mortality.

Conclusions: LCBDE is a feasible, safe and effective procedure that carries a low morbidity and mortality and will decrease the need for unnecessary ERC in the future for suspected or proved choledocholithiasis.

Section snippets

Transcystic common bile duct exploration

The TC-CBDE technique involves CBDE through the cystic duct, which is incised in its larger portion closer to the CBD so that less cystic duct dilatation is required and quick access to the CBD is gained. The hydrophilic guidewire is then passed into the cystic duct, over which either balloon dilating catheters or sequential bougies are inserted to dilate the cystic duct to the size of the largest calculus. The majority of surgeons avoid dilating the cystic duct beyond 8 mm in diameter because

LCBDE for suspected or proved CBDS: literature review

During the early development of LC, patients with the slightest suspicion of CBDS underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) with a view that if stones were discovered they could be removed either using ES or OCBDE. However, the use of preoperative ERCP is increasingly being challenged because it is costly; in the majority of cases, it is normal18, 19, 20; there is a risk of life-threatening complications such as bleeding (3%), pancreatitis (2%), duodenal

LCBDE versus endoscopic spincterotomy

Liberman et al43 compared LC plus TC-CBDE (group 1) with LC plus ES (group 2) at a single institution. There were 59 patients in group 1 and only 17 patients in group 2. The procedure success rate for group 1 patients was 86% (51 patients). There was 1 conversion due to CBD perforation, 6 known retained stones requiring subsequent ES, and 1 unrecognized retained CBDS. There were 7 complications and 1 death. There were 4 retained stones in group 2, 2 each in pre- and post-ES groups. Seven

Conclusions

Laparoscopic common bile duct exploration is a feasible, safe and effective procedure that carries a low morbidity and mortality. The use of real time on table cholangiography should be used in a selected group of patients (history of jaundice, pancreatitis, and so forth) in order to correctly identify those harbouring CBDS. These patients will require LCBDE at the time of LC. The applicability of LCBDE will be dictated by the suitability of the patient to undergo a more prolonged procedure,

References (45)

  • R.M. Mazzariello

    A fourteen-year experience with nonoperative instrument extraction of retained bile duct stones

    World J Surg

    (1978)
  • Classen M, Demling L. Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal...
  • F. Dubois et al.

    Cholecystectomy by coelioscopy

    Presse Medicale

    (1989)
  • M. Jacobs et al.

    Laparoscopic choledocholithotomy

    J Laparoendosc Surg

    (1991)
  • J.B. Petelin

    Laparoscopic common bile duct explorationtranscystic duct approach

  • Y.M. Dion et al.

    Common bile duct explorationthe place of laparoscopic choledochotomy

    Surg Laparosc Endosc

    (1994)
  • A. Cuschieri et al.

    Common bile duct exploration via laparoscopic choledochotomy

  • A.L. DePaula et al.

    Laparoscopic antegrade sphincterotomy

    Surg Laparosc Endosc Percutan Tech

    (1993)
  • E. Lezoche et al.

    Laparoscopic treatment of gallbladder and common bile duct stonesa prospective study

    World J Surg

    (1996)
  • M.J. Curet et al.

    Laparoscopic antegrade sphincterotomy. A new technique for the management of complex choledocholithiasis

    Ann Surg

    (1995)
  • H. Rijna et al.

    Selective preoperative endoscopic retrograde cholangiopancreatography in laparoscopic biliary surgery

    Br J Surg

    (1995)
  • G.C. Vitale et al.

    The use of ERCP in the management of common bile duct stones in patients undergoing laparoscopic cholecystectomy

    Surg Endosc

    (1993)
  • Cited by (0)

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