Laparoscopy in 612 patients with common bile duct stones. A French retrospective multicenter study

Objective - To analyse retrospectively the results of one-stage laparoscopi c treatment for common centers in France. Patients - From January 1991 to July 1996, 612 patients with choledocholith iasis underwent laparoscopic treatment. Results - Overall duct clearance was obtained in 489 of the 612 patients (8 0%) : through the cystic duct in 222 of 380 patients (58.4%), by secondary choledochotomy (after unsuccessful transcystic duct extraction) in 77 of 96 (80%), and in 190 of 232 (82%) by primary choledochotomy. The overall duct clearance rate increased From 65% in 1991 to 84% in 1996. The use of the c holedochotomy approach increased From 43% in 1991 to 69% in 1996 (P < 0.01) , due to a substantial increase in primary choledochotomy. In contrast, the use of the transcystic approach decreased from 57% to 37% (P < 0.01). The mean time for surgery was shorter for cystic duct exploration than for prim ary choledochotomy (101 +/- 51 vs. 155 +/- 62 min, P < 0.0001). The mean ho spital stay decreased from 7.7 +/- 3.6 days in 1991 to 4.1 +/- 2 days in 19 96 (P < 0.007). The main biliary complications were related to biliary drai nage (2,8%) and retained stones (3.1%). Conclusion - This study confirms that laparoscopy is a good alternative wit h a low complication rate, a short hospital stay, and is an effective and s afe option for the management of common bile duct stones.