LAPAROSCOPIC TREATMENT OF GALLBLADDER AND COMMON BILE-DUCT STONES - APROSPECTIVE-STUDY

The aim of this study was to investigate prospectively the feasibility , success rate, safety, and short-term results of single-stage laparos copic treatment of gallstones and ductal stones in 100 consecutive, un selected patients. Common bile duct (CBD) stones were diagnosed at rou tine intraoperative cholangiography and choledochoscopy in 100 of 950 patients with gallstones undergoing laparoscopic cholecystectomy (LC), Unsuspected CBD stones were present in 39 patients (4.1% of 950; 39% of 100); 26 patients were referred for surgery after failed endoscopic sphinctertomy (ES) performed elsewhere, Transcystic duct CBD explorat ion (TC-CBDE) was the procedure of choice. When it was not feasible, c holedochotomy and direct CBD exploration (D-CBDE) was performed. Use o f biliary drainage was liberal, ri completion cholangiogram was obtain ed for all patients. Laparoscopic treatment of CBD stones was successf ul in 96 patients: after TC-CBDE in 63 and after D-CBDE in 33, Four op erations were converted to open surgery (4%). Retained stones, observe d in five patients, were treated by ES in two cases and by percutaneou s endoscopic/fluoroscopic lithotripsy in three, Minor morbidity includ ed biloma (n = 2), port site infection (n = 2), and subumbilical hemat oma (n = 1). Major morbidity was bile leakage from the cystic duct stu mp in two cases due to clips or transcystic duct drainage displacement , respectively. One elderly, high risk patient died after being referr ed for several failed attempts of endoscopic clearance; she died from cardiogenic shock 3 days after successful laparoscopic treatment. Lapa roscopic CBD exploration is feasible and safe in most patients, with s hort-term results that compare favorably with the results of sequentia l ES/LC reported in the literature.