A PROSPECTIVE MULTICENTER STUDY OF 189 PA TIENTS UNDERGOING LAPAROSCOPIC TREATMENT OF CHOLEDOCOLITHIASIS

Objectives. - The aim of this study was to assess the feasibility and results of common bile duct laparoscopic treatment and exploration in patients with choledocolithiasis. Patients and methods. - From Novembe r 1991 to December 1994, 189 consecutive malades (120 females; mean ag e 68 years, range: 21-92) with choledocholithiasis identified during r outine intraoperative cholangiogram underwent surgical exploration of common bile duct in 5 surgical centers. Twenty patients were referred to surgery after unsuccessful endoscopic sphincterotomy. Results. - Fo llowing laparoscopic exploration and intraoperative cholangiography, c ommon bile duct stone extraction by laparoscopy was not attempted in I I patients (5.8 %). The common bile duct was successfully cleared of a ll stones in 153 patients (81 % of the overall population and 86 % of laparoscopic attempts), either via the transcystic route (n = 97) or t hrough choledocotomy (n = 56). Eighteen patients required conversion t o open surgery, 16 for unsuccessful stone extraction and 2 despite suc cessful stone extraction. Postoperative endoscopic sphincterotomy was required in 7 patients (4.4 %) for retained stones after laparoscopic treatment. There were no postoperative deaths (95 % confidence interva l 0-1.6 %), and follow-up, ranging from 3 to 42 months, has shown no f urther clinical evidence of retained stones. Conclusion. - Diagnosis a nd treatment of common bile duct stones is feasible by laparoscopy, an d the results in this series compare favorably with those of conventio nal surgical treatment. Complete treatment of biliary lithiasis, in on e operation, avoids the pitfalls of patient selection for preoperative endoscopic retrograde cholangiography and the risks of endoscopic sph incterotomy.