LAPAROSCOPIC MANAGEMENT OF CHOLEDOCHOLITHIASIS

The authors report on a group of 114 patients with common bile duct (C BD) stones who were treated by laparoscopic surgery. Management throug h the cystic duct was considered the first option. Choledochotomy was used for those patients in which the cystic approach was not possible or was unsuccessful. Transcystic lithotrispy was considered for patien ts with CBD stones in disproportion with the size of the cystic duct. Laparoscopic antegrade sphincterotomy was indicated as a drainage proc edure. The transcystic approach was used in 89.5% of the patients; cho le-dochotomy was used in 6.2%; and both ways were used in 4.3%. DXffer ent procedures were used, including mechanical and electrohydraulic li thotripsy, choledochotomy with T-tube or endoprostheses drainage, lapa roscopic sphincterotomy, end-to-end common bile duct anastomosis, and choledochoduodenum anastomosis. One of the patients was in the 21st we ek of pregnancy. The laparoscopic approach to choledocholithiasis was successfully performed in 94.8% of the patients. Mean hospital stay wa s 1.7 days. There was a 6.2% incidence of complications and the mortal ity rate was 0.9%. In 84.3% of the patients, the transcystic approach was used successfully, with a complication rate of 4.9% and a mean hos pital stay of 1.6 days. Three patients were converted to open surgery early in this series. Thus far, one patient has presented residual CBD stones. The results obtained suggest that laparoscopic common bile du ct exploration is a technically feasible procedure, with low complicat ion and mortality rates, although it requires adequate selection of pa tients and a variety of techniques and types of equipment.