[Laparoscopic treatment of choledocolithiasis]

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Tract Diseases

Context:

• Choledocholithiasis, the presence of stones in the common bile duct, affects a significant number of patients requiring surgical intervention.
• Laparoscopic surgery has become a preferred approach for many abdominal conditions, but its application in complex choledocholithiasis cases requires careful consideration.

Purpose:

• To evaluate the safety, efficacy, and outcomes of laparoscopic treatment for choledocholithiasis.
• To identify factors influencing conversion rates from laparoscopic to open surgery.
• To determine the optimal patient selection criteria for laparoscopic choledocholithiasis management.

Summary:

• A five-year study involved 52 patients with choledocholithiasis, with 38 undergoing laparoscopy, 10 open laparotomy, and 4 sequential treatment.
• The laparoscopic approach had a 39% conversion rate, attributed to unselected cases including acute cholangitis, impacted stones, and severe inflammation.
• No mortality or morbidity was observed; laparoscopic procedures averaged 165 minutes with an 8.8-day hospital stay. Two residual stones were managed endoscopically.

Impact:

• Laparoscopic treatment of choledocholithiasis is a safe and effective option, offering a viable alternative to open surgery.
• Implementing stricter patient selection criteria, particularly excluding cases with acute cholangitis and multiple common bile duct stones, can significantly reduce conversion rates.
• While requiring specialized equipment and surgical expertise, laparoscopy provides excellent outcomes for choledocholithiasis when appropriately applied.