Laparoscopic management of common bile duct stones.

Background. The aim of this prospective study was the evaluationof the results of laparoscopic management of common bile ductstones (CBDS).Material and methods. From October 1990 to December 2004, allthe 476 patients who underwent laparoscopic management ofCBDS were included in a prospective study. Mean age of the patientswas 63 years (range: 19 to 93). Three hundred and eighty ninepatients were ASA1-ASA2 and 85 patients were ASA3-ASA4.CBDS were suspected or diagnosed pre-operatively in 201 patients(63%) and at intraoperative cholangiography in 175 patients (37%).A transcystic duct extraction (TCDE) was attempted in 238 patientsand a choledochotomy in 288, primarily in 237 patients and afterfailure of TCDE in 51 patients. A biliary drainage after choledochotomywas used in 152cases (52%).Results. TCDE was successful in 176 cases (73.5%). The 62 failureswere managed by laparoscopic choledochotomy in 51 casesand by endoscopic sphincterotomy (ES) in 11 cases. Overall acholedochotomy was performed in 288 cases and was successful in278 cases (96.5%). The 10 failures were managed by 7 conversions(2.4%) into laparotomy and 3 postoperative ES. The overall successrate was 95.6%.The morbidity rate was 7.9% with 4.6% of localcomplications and 3.3% of general complications. The mortalityrate was 1 %. There were 12 residual stones (2.5%) which weremanaged by a second laparoscopy in 2 cases and ES in 10 caseswith 4 failures managed by laparotomy in 1 case and laparoscopy in2 cases.Conclusion. Laparoscopic management of CBDS is effective inmore than 95 % of cases and particularly safe in ASA 1 and ASA 2patients. It has the advantage over ES followed by cholecystectomyto be a single-stage procedure.