LAPAROSCOPIC COMMON BILE-DUCT EXPLORATION BY CHOLEDOCHOTOMY - AN EFFECTIVE AND EFFICIENT METHOD OF TREATMENT OF CHOLEDOCHOLITHIASIS

Background: Management of cholelithiasis and choledocholithiasis usual ly requires two separate teams-the gastroenterologist/surgical endosco pist and the laparoscopic surgical team. This requires two separate pr ocedures that potentially increase the overall morbidity and cost. Lap aroscopic common bile duct exploration by choledochotomy (LCBDE-C) ave rts this problem with a single approach.Methods: In 1990-1991, unsuspe cted stones found at laparoscopy with intraoperative cholangiogram don e routinely underwent postoperative ERCP. Residual stones had been fou nd after ERCP in 16 of 22 preoperative ERCP patients and we began to s eek an alternative technique. Laparoscopic common bile duct exploratio n by choledochotomy has achieved a high rate of success. Results: Tech nically successful LCBDE-C has been accomplished in 143 of 148 patient s (96.6%). Retained bile duct stones have been found on postoperative cholangiogram in three patients (2.0%), all of which have been success fully removed by postoperative ERCP. Thus 140 or 148 patients had thei r bile duct successfully cleaned by the one-step technique alone (94.6 %). Conclusions: We believe that most laparoscopic surgeons who have a cquired the skills of intracorporeal suturing can be successful at lap aroscopic common bile duct exploration by choledochotomy. The disadvan tage of T-tube presence will likely be eliminated by future developmen ts with intraoperative antegrade sphincterotomy-like procedures, but t he ability to see both proximal and distal biliary tree with the chole dochotomy in all cases seems to offer more than adequate results at th is point in the evolution of the laparoscopic approach to calculus bil iary tract disease.