LAPAROSCOPIC EXPLORATION OF INTRAHEPATIC AND EXTRAHEPATIC BILE-DUCTS AND T-TUBE DRAINAGE

Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for the management of patients with gall-Madder stones. This co ntrasts with patients who have common bile duct and intrahepatic duct stones who still usually need an open operation. On the basis of exper ience of a number of LC by one surgeon and animal experiments, we have completed laparoscopic exploration of both intra- and extrahepatic du cts and T-tube drainage of 57 patients with intra- and extrahepatic bi le duct calculi over 13 months during 1992-1993 with satisfactory resu lts. The average operating time was 150 min, with a range of 100 to 22 0 min. Most patients were mobile and on oral fluids within 24 h postop erative. Average hospital stay was 4 days. Retained stones were found via T-tube cholangiography in four patients (7%) and for each patient these were removed by fibre-optic choledochoscope 2 weeks postoperativ ely. Laparoscopic exploration of intra- and extrahepatic bile ducts is achievable by experienced surgeons and may be particularly helpful fo r patients who are not a good operative risk.