Laparoscopic Bile Duct Clearance Without Choledochoscopy

摘要

Background:Laparoscopic common bile duct exploration (LCBDE) has been proven to be a safe, efficient, and cost-effective option for the management of common bile duct (CBD) stones. There are two guiding methods during LCBDE: fluoroscopic or choledochoscopic. Most surgeons prefer the use of flexible choledochoscopy at LCBDE, but it is a fragile, delicate, and expensive instrument. The aim of this work was to report our experience in fluoroscopically guided LCBDE.Patients and Methods:A retrospective review of all patients who underwent LCBDE in the Mansoura Gastroenterology surgical center between March 2007 and September 2014 was performed. Patients with gallstones and concomitant CBD stones were included. After the initial assessment, all patients fulfilling the criteria of enrollment underwent magnetic resonance cholangiopancreatography, and only patients with magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography evidence of CBD stones were included. Choledochoscopy was not used in any patient, and we depended on fluoroscopic guidance for CBD stone retrieval in all LCBDE.Results:A total of 290 patients were assessed for LCBDE: 76 patients were excluded; 11 patients were not completed laparoscopically due to negative intraoperative cholangiography (n=7) and conversion to laparotomy (n=4); the remaining 203 patients were analyzed. LCBDE failed in 16 of the 203 (7.9%) cases, with a success rate of 92.1%. The median operative time was 79 minutes, and the median hospital stay was 2.4 days. Complications were bile leakage (n=4), mild pancreatitis (n=2), wound infection (n=2), port hernia (n=1), and internal hemorrhage (n=1).Conclusions:Compared with published studies using choledochoscopy at LCBDE, we found comparable results in terms of the success/failure rate, the morbidity and mortality, the operative time, and the length of hospital stay. LCBDE under fluoroscopic guidance may be as safe and efficient as with choledochoscopic guidance.