Laparoscopic common bile duct exploration - Long-term outcome

Hypothesis: Transcystic laparoscopic common bile duct exploration (LCBDE) w ith biliary endoscopy results in excellent long-term clinical outcome and p atient satisfaction. Design: Prospective cohort study of unselected patients found to have commo n bile duct stones during laparoscopic cholecystectomy between October 1989 and April 1998. A mailed survey assessed symptoms, outcome, and satisfacti on. Setting: A large community teaching hospital. Patients: Two hundred seventeen patients with common bile duct stones. Intervention: Transcystic LCBDE with choledochoscopy. Main Outcome Measures: Success of LCBDE, morbidity, postoperative symptoms, and satisfaction. Results: One hundred sixteen surveys (54%) were returned. Mean follow-up wa s 60 months. The LCBDE procedure failed in 6 patients and endoscopic retrog rade cholangiopancreatography was performed in 4 patients (3%). One patient had unsuspected retained stones. No patient had late recognition of retain ed stones or a bile duct stricture. Abdominal pain was present in 90 patien ts (89%) preoperatively and in 29 patients (26%) postoperatively (P = .001) . The LCBDE procedure reduced 3 specific pain profiles: epigastric, from 47 % (n = 54) to 7% (n = 8); back, from 31% (n = 36) to 6% (n = 7); and should er, from 18% (n = 21) to 2% (n = 2). When pain persisted, it was different in character in 15%. All nonpain symptoms (such as nausea, bloating, indige stion, and gas) were reduced from 78% (n = 91) to 34% (n = 39) (P = .001) e xcept diarrhea. Diarrhea was present in 24 patients (22%) preoperatively an d postoperatively, though it was a new postoperative symptom in 11 patients (11%). One hundred two patients (95%) were satisfied or mostly satisfied w ith LCBDE. Conclusions: Pain and nonpain symptoms, while reduced significantly after L CBDE, may persist. The LCBDE procedure does not result in common bile duct strictures or a significant rate of retained stones. This relatively new tr eatment for common bile duct stones is safe and effective.