Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre

CN Tang, KK Tsui, JPY Ha, WT Siu, MKW Li
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong

OBJECTIVES. To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones.

DESIGN. Retrospective study.

SETTING. Regional minimal access surgery training centre in Hong Kong.

PATIENTS. Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005.

MAIN OUTCOME MEASURES. Demographic information, reasons for failed endoscopic
retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality.

RESULTS. A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months.

CONCLUSIONS. Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Hong Kong Med J 2006;12:191-6

Key words: Cholangiopancreatography, endoscopic retrograde; Cholecystectomy, laparoscopic; Common bile duct/surgery; Gallstones/surgery; Sphincterotomy, endoscopic