LAPAROSCOPIC TREATMENT OF COMMON BILE-DUCT STONES

Background/Aims: Laparoscopic exploration, of the common bile duct is technically possible. The aim of this prospective study was to evaluat e the feasibility of the different techniques of laparoscopic treatmen t of common bile duct stones and their complications. Materials and Me thods: From October 1990 to December 1995, 161 patients, age from 18 t o 92, underwent a Laparoscopic treatment for choledocholithiasis. A tr anscystic approach was attempted in 82 patients and was successful in 55 (67%). The failures were treated by 22 laparoscopic choledochotomie s and in five patients by postoperative endoscopic sphincterotomy. A c holedochotomy was performed in 101 cases and was successful in 97 (96% ). The failures were treated by three laparotomies with a failure of i ntra-hepatic stone extraction and one postoperative endoscopic sphinct erotomy. There were four residual lithiasis treated with endoscopic sp hincterotomy. There were two failures treated one by laparotomy and on e by laparoscopy. The total success rate was 92% (148/161). Results: T here was no postoperative mortality. There were five local complicatio ns, two abscesses, one Liver injury, one smalt hemorrhage at the troca r site, and one pain lasting for more than 48 hours. There were seven, general complications: two cardiac failures (medical treatment), one severe pancreatitis, one digestive hemorrhage, one psychiatric disorde r, and two postoperative ileus. The total morbidity rate was 7.4% (12/ 161). Mean. hospital stay was 7.6 days (2-36). Conclusions: Laparoscop ic exploration of the common, bile duct appears to be safe and effecti ve. It could be included in the protocol of management of choledocholi thiasis.