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Laparoscopic trans-cystic-duct common-bile-duct exploration
E H Phillips1, R J Rosenthal, B J Carroll
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Surgical Endoscopy
|December 1, 1994
Summary
Trans-cystic-duct extraction (TCD-CBDE) safely removes common bile duct stones (CBDS) during laparoscopic cholecystectomies. This effective technique, primarily using biliary endoscopy, offers a high success rate with manageable complications.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Hepatobiliary Surgery
Background:
- Laparoscopic cholecystectomy is a common procedure.
- Common bile duct stones (CBDS) can complicate cholecystectomies.
- Routine cholangiography aids in detecting CBDS.
Purpose of the Study:
- To evaluate the safety and efficacy of trans-cystic-duct extraction (TCD-CBDE) for common bile duct stones.
- To analyze the techniques and outcomes of TCD-CBDE.
- To identify factors influencing complications in patients with CBDS.
Main Methods:
- Prospective analysis of 1071 laparoscopic cholecystectomies.
- Routine intraoperative cholangiography.
- Trans-cystic-duct extraction (TCD-CBDE) for 111 patients with CBDS.
- Detailed recording of techniques, operative time, and outcomes.
Main Results:
- 130 patients (12%) had CBDS, 48 (37%) unsuspected.
- TCD-CBDE was successful in 103 (93%) of 111 attempted cases.
- Biliary endoscopy was the primary TCD-CBDE technique (101 patients).
- Average operative time: 136 minutes; average postsurgical stay: 3.7 days.
- 17% complications (5% major); 4 retained stones; 1 death.
Conclusions:
- Trans-cystic-duct extraction (TCD-CBDE) is a safe and effective method for removing common bile duct stones.
- Biliary endoscopy and basket stone retrieval are primary TCD-CBDE techniques.
- Patient age influences complication rates; younger patients with unsuspected CBDS had fewer complications.