Laparoscopic treatment of common bile duct stones

Laparoscopic exploration of the common bile duct is technically possible. The aim of this prospective study was to evaluate the feasibility of the different techniques of laparoscopic treatment of common bile duct stones and their complications.

From October 1990 to December 1995, 161 patients, age from 18 to 92, underwent a laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 82 patients and was successful in 55 (67%). The failures were treated by 22 laparoscopic choledochotomies and in five patients by postoperative endoscopic sphincterotomy. A choledochotomy was performed in 101 cases and was successful in 97 (96%). The failures were treated by three laparotomies with a failure of intra-hepatic stone extraction and one postoperative endoscopic sphincterotomy. There were four residual lithiasis treated with endoscopic sphincterotomy. There were two failures treated one by laparotomy and one by laparoscopy. The total success rate was 92% (148/161).

There was no postoperative mortality. There were five local complications, two abscesses, one liver injury, one small hemorrhage at the trocar site, and one pain lasting for more than 48 hours. There were seven general complications: two cardiac failures (medical treatment), one severe pancreatitis, one digestive hemorrhage, one psychiatric disorder, and two postoperative ileus. The total morbidity rate was 7.4% (12/161). Mean hospital stay was 7.6 days (2-36).

Laparoscopic exploration of the common bile duct appears to be safe and effective. It could be included in the protocol of management of choledocholithiasis.