LAPAROSCOPIC TREATMENT FOR CHOLEDOCHOLITHIASIS - A PROSPECTIVE EVALUATION IN 247 CONSECUTIVE UNSELECTED PATIENTS

Background/Aims: Evaluation of the feasibility and results of the one- stage treatment combining routine intraoperative cholangiography and l aparoscopic common. bile duct exploration for choledocholithiasis. Pat ients and Methods: Multicentric (5 centers-9 surgeons) prospective stu dy in 247 consecutive patients (mean age 68 years; range 21-92) during a 50-month period (November 1991-December 1995). Laparoscopic treatme nt of choledocholithiasis teas attempted irrespective of the circumsta nces leading to the diagnosis of biliary lithiasis or the preoperative suspicion. of choledocholithiasis. Results: One out of four patients (n=61) had unsuspected choledocholithiasis disclosed by routine intrao perative cholangiography. A laparoscopic complete clearance of choledo cholithiasis was achieved in 208 of 236 attempted cases (88%), with ei ther transcystic duct extraction (n=116) or choledochotomy (n=92). Ope n, surgery was required in 20 patients for failure of Laparoscopic tre atment and in 3 patients despite successful extraction. Twenty-one of 25 patients (84%) referred for failure of retrograde endoscopic stone extraction had successful laparoscopic choledocholithiasis clearance. The mean duration for the laparoscopic transcystic approach and choled ochotomy were 108 min. (range 50-300) and 173 min. (range 70-480), res pectively. Eleven patients had retained stones (4.4%). Minor and major complications were recorded in 9 and 22 patients respectively. The op erative mortality was 0.4% (95% confidence interval: 0-1.2%). Conclusi on: Intraoperative cholangiography during laparoscopic cholecystectomy and Laparoscopic common bile duct exploration when required should be considered as the simplest and most efficient treatment for choledoch olithiasis. The multicenter character of this study including consecut ive patients from public and private practices, strengthens our conclu sions and is consistent with a wide diffusion, of this diagnostic and therapeutic strategy.