LAPAROSCOPIC CHOLEDOCHOTOMY WITH PRIMARY CLOSURE - FOLLOW-UP (5-44 MONTHS) OF 31 PATIENTS

Background: Thirty-three patients were candidates for laparoscopic cho ledochotomy. The indications for this operation are described. Methods . The procedure was completed 32 times (97%). We had 29 successful com mon bile duct (CBD) clearances, three negative explorations, and one f ailed clearance which needed to be converted to laparotomy. All the co mpleted procedures ended with primary closure of the main duct. Median duration of surgery was 180 min (range 100 - 300), including three as sociated laparoscopic procedures.Results: There were three postoperati ve complications (9.3%), none major. Average postoperative hospital st ay was 7.1 days (range 4 - 14). In May - June 1995 we controlled 31 ou t of the 32 consecutive patients (one patient was lost to follow-up) w ho had a successful laparoscopic choledochotomy from October 1991 to D ecember 1994. Median follow-up was 22 months (range 5 - 44). Besides c linical control, 23 patients also had ultrasound (US) controls and 24 had blood tests. Eleven had intravenous cholangiotomography. Two patie nts died 11 and 22 months after the operation for unrelated causes and without biliary symptoms. Two patients had umbilical hernias. One had a small residual asymptomatic stone, which was removed endoscopically . None had signs of postoperative CBD stricture. At US, CBD was less t han or equal to 7 mm in 15 patients, 8 - 10 mm in four patients, and 1 0 - 12 mm in three patients. The last group had preoperative CBD dilat ion, too. We could compare preoperative and postoperative CBD diameter s in 22 patients: 11 had no change; in nine it decreased; and two had a slight increase (8 - 10 mm). Conclusions: We conclude that laparosco pic choledochotomy with primary closure is a very good operation: It h as a high success rate and low morbidity. Mortality is nil so far. Med ium-term results are very positive: We had no CBD stricture and only o ne case of asymptomatic residual stone, which could have been avoided. Our results suggest that intraductal biliary drainage is useless, and its specific complications are well known.