LAPAROSCOPIC TREATMENT OF COMMON BILE-DUC T STONES

Laparoscopic exploration of the common bile duct is now technically po ssible, This prospective study evaluates the feasibility of the differ ent techniques and their complications. From January 1990 to March 199 5, 140 patients, aged from 22 to 92, underwent laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 70 pa tients and was successful in 46 (65.7%). The failures were treated by 19 laparoscopic choledochotomies and 5 postoperative endoscopic sphinc terotomies. A choledochotomy was performed in 89 cases and was success ful in 85 (94.4%). The failures were treated by 3 laparotomies and 2 p ostoperative endoscopic sphincterotomy. The total success rate was 92. 8% (130/140). The 5 local complications were pain (1), liver injury (1 ), and wound abscess (2), bleeding from a trocar site. Heart failure ( medical treatment) (2), gastrointestinal haemorrhage from intestinal a ngiomas, severe pancreatitis after transcystic failure and psychiatric disorders were the 5 general complications. The total morbidity rate was 7.1%. There were 2 residual common bile duct stones. The mortality rate was 0. Mean hospital stay was 7.8 days. Laparoscopic exploration of the common bile duct appears to be safe and effective and should b e included in the management protocol of choledocholithiasis.