EVALUATION OF LAPAROSCOPIC MANAGEMENT OF COMMON BILE-DUCT STONES IN 220 PATIENTS

Background: The aim of this study was to evaluate the feasability and results of laparoscopic management of common bile duct stones (CBDS). Methods: From October 1990 to November 1996, 220 patients with CBDS ha ve been managed laparoscopically, CBDS were suspected or diagnosed pre operatively in 130 patients (59.1%) and at intraoperative cholangiogra phy (IOC) in 90 patients (40.9%). A transcystic duct extraction (TCDE) was attempted in 112 patients and a primary choledochotomy in 108 pat ients. Results: TCDE was successul in 77 cases (68.8%). The 35 failure s were treated by 29 laparoscopic choledochotomies, 1 intraoperative a nd 5 postoperative endoscopic sphincterotomies (ES). A choledochotomy was thus performed in 137 cases and was successful in 133 cases; (97.1 %). The four failures were managed by three laparotomies and one posto perative ES, The overall success rate was 95.5% (210/220), There was 4 deaths (0.9%) within the 1(st) postoperative month in ASA 3 patients and the morbidity rate was 9.1% (20/220), There were 7 residual stones (3.2%). Conclusions: Laparoscopic desobstruction of CBDS appears to b e safe and effective and has the advantage to be a single-stage proced ure, It could become in the future with refinement of instrumentation and skill of surgeons the best treatment for the majority of patients harboring CBDS.