LAPAROSCOPIC COMMON BILE-DUCT EXPLORATION

Objective: To explore the feasibility of laparoscopic techniques for t he removal of common bile duct (CBD) stones. Design: Retrospective ana lysis. Setting: University hospital, Sweden. Subjects: 39 patients who underwent laparoscopic common bile duct exploration, either by a tran scystic technique or by choledochotomy, between September 1992 and Apr il 1995. Interventions: Cholecystectomy, intraoperative cholangiograph y, and removal of CBD-stones by a transcystic technique (n = 22), lapa roscopic choledocholithotomy (n = 11), or after conversion to open cho ledocholithotomy (n = 6). Main outcome measures: Stone clearance rates , operative time, complications, and postoperative hospital stay. Resu lts: Stone removal was achieved in 32/39 patients (82%) by a laparosco pic approach. Reasons for failure were early in our experience, and th e result of technical difficulties or stones that were too large for t he transcystic approach, or with impacted stones at choledochotomy. Po stoperative morbidity was low (n = 4, 10%) with no mortality. Conclusi ons: Common bile duct stones can be removed in a large proportion of p atients undergoing laparoscopic cholecystectomy, either by a laparosco pic transcystic technique or through a laparoscopic choledochotomy. Th e laparoscopic techniques need further evaluation, preferably in prosp ective multicentre trials comparing other treatment strategies includi ng endoscopic sphincterotomy.