PROSPECTIVE EVALUATION IN 121 CONSECUTIVE UNSELECTED PATIENTS UNDERGOING LAPAROSCOPIC TREATMENT OF CHOLEDOCHOLITHIASIS

Laparoscopic common bile duct (CBD) exploration was attempted in 115 o f 121 consecutive unselected patients with choledocholithiasis (mean a ge 69 (range 21-92) years) found during routine intraoperative cholang iography. The CBD was successfully cleared of all stones in 100 patien ts (87 per cent). Ten of 11 patients referred for surgery after failur e of endoscopic sphincterotomy had complete laparoscopic choledocholit hiasis. Eleven patients (10 per cent) required conversion to open CBD exploration, and laparoscopic exploration was not attempted in six (5 per cent) because of inflammation or fibrosis. Postoperative endoscopi c sphincterotomy was required in four patients (4 per cent) for retain ed stones after laparoscopic exploration. There were no postoperative deaths (39 per cent of patients were aged 75 years or more). Routine i ntraoperative cholangiography, and when required laparoscopic CBD expl oration, should be compared in randomized trials with preoperative end oscopic retrograde cholangiography in patients with suspected choledoc holithiasis.