Can common bile duct stones be removed laparoscopically without biliary drainage?

Aim of the study - To evaluate the indications, feasibility and results of laparoscopic treatment of common bile duct stones without biliary drainage. Patients and methods - Between 1992 and 1999, laparoscopic procedures were performed in 70 consecutive patients, mean age 60 +/- 15 years (range: 18-8 2). Stone removal was attempted via the cystic duct (n = 25) or choledocoto my (n = 45). The emptiness of the common bile duct was checked by intraoper ative cholangiography or endoscopy. After choledocotomy, closure was perfor med by interrupted or non-interrupted suture with slowly resorbable thread. Transcystic drainage was used whenever necessary. Results - Nine conversions to laparotomy were necessary (12.8%). Among the 61 patients who had an exclusively laparoscopic procedure, 21 were treated via the transcystic route and 40 through choledocotomy. Biliary endoscopy w as possible in only 10 of the 21 patients (47.6%) treated via the transcyst ic route and in all with choledocotomy. No biliary drainage was used in 16 of the 21 patients treated via the transcystic route and in 39 of the 40 tr eated through choledocotomy. The 30-day mortality was 1/61 (1.6%). Morbidit y was 9.8% and 2 patients underwent a second laparoscopic procedure lone fi stula on a choledocotomy suture, one hemoperitoneum of unknown origin). An endoscopic sphincterotomy for residual stone was necessary in 4 patients (4 /61, 6.5%), 2 after choledocotomy for an unrecognized stone without biliary drainage. Conclusions - These results confirm the Feasibility of laparoscopic treatme nt of common bile duct stones and suggest if can be performed without bilia ry drainage in most cases.