LAPAROSCOPIC MANAGEMENT OF COMMON BILE-DUCT CALCULI

In the period November 1991 to October 1993 altogether 418 patients un derwent laparoscopic cholecystectomy in our unit. Routine intraoperati ve cholangiography, a prerequisite for diagnosing choledocholithiasis, was successful in 99.3% of cases. 38 patients were found to have comm on bile duct calculi and their management and follow up are reported i n this study. In 36 cases stones were successfully eliminated by means of the laparoscopic procedure, via the cystic duct in 22 cases and by choledochotomy in 14 cases. One patient required postoperative endosc opic papillotomy, and in the remaining case surgical management was ch anged to classical laparotomy and open choledochotomy. Postoperative c omplications occurred in five cases. One patient suffering from bacter ial peritonitis underwent laparotomy on the 9th postoperative day, ano ther with postoperative bleeding from the cystic artery was relaparosc opied on the same day as the minimal invasive procedure. One patient d eveloped a liver abscess three weeks after operation, requiring draina ge with the aid of ultrasound. A superficial wound infection in one pa tient and biliary leakage after removal of the T-tube in another patie nt both healed spontaneously. Our results are similar to those obtaine d with other therapeutic concepts. Because the papilla of Vater remain s intract in minimal invasive surgery, which causes relatively little stress to the patient, as well as considering the economic advantages of a single-step procedure, this management strategy can be recommende d as a valuable alternative procedure.