Ann Surg Treat Res.  2014 Jan;86(1):1-6. 10.4174/astr.2014.86.1.1.

Long-term results of laparoscopic common bile duct exploration by choledochotomy for choledocholithiasis: 15-year experience from a single center

• Lee HM
• Min SK
• Lee HK

• KMID: 2266899
• DOI: http://doi.org/10.4174/astr.2014.86.1.1

Abstract

PURPOSE
The aim of this study is to assess the long-term results of laparoscopic common bile duct exploration (LCBDE) and validate its effectiveness as a primary treatment modality for CBD stone.
METHODS
A retrospective review of the medical records of 157 patients who underwent LCBDE from 1997 to 2011 was conducted. All LCBDE were performed by choledochotomy. Clinical demographics, operative outcome, recurrence rate of CBD stones, and long-term bile duct complications were analyzed. The mean follow-up period was 51.9 months.
RESULTS
LCBDE was completed in 152 patients (96.8%) and 5 patients (3.2%) had open conversion. The male/female ratio was 78/79 and mean age was 67.3 years. Stone clearance was successful in 149 of 152 patients (98.0%). Nonlethal complications were noted in 11 patients (7.2%), including bile leakage in 6 patients (3.9%). Recurrent CBD stones developed in 9 of 152 patients (5.9%). Preoperative endoscopic sphincterotomy (P = 0.492) and choledochotomy repair type (T-tube drainage vs. primary closure, P = 0.740) were not significantly related to stone recurrence. There were no signs of any type of biliary injury or stricture observed in any of the patients during the follow-up period.
CONCLUSION
LCBDE can be performed without increased risk of long-term complications such as bile duct stricture and recurrent CBD stones. LCBDE is a safe and effective treatment option for choledocholithiasis in terms of long-term outcome as well as short-term outcome.

Keyword

Choledocholithiasis; Laparoscopic surgery; Common bile duct

MeSH Terms

Bile
Bile Ducts
Choledocholithiasis*
Common Bile Duct*
Constriction, Pathologic
Demography
Drainage
Follow-Up Studies
Humans
Laparoscopy
Medical Records
Recurrence
Retrospective Studies
Sphincterotomy, Endoscopic

Reference

1. Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg. 2002; 89:1495–1504.

2. Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009; 104:31–40.

3. Schreurs WH, Juttmann JR, Stuifbergen WN, Oostvogel HJ, van Vroonhoven TJ. Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc. 2002; 16:1068–1072.

4. Dorman JP, Franklin ME Jr. Laparoscopic common bile duct exploration by choledochotomy. Semin Laparosc Surg. 1997; 4:34–41.

5. Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M, et al. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008; 57:1004–1021.

6. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999; 13:952–957.

7. Dorman JP, Franklin ME Jr, Glass JL. Laparoscopic common bile duct exploration by choledochotomy. An effective and efficient method of treatment of choledocholithiasis. Surg Endosc. 1998; 12:926–928.

8. Escarce JJ, Shea JA, Chen W, Qian Z, Schwartz JS. Outcomes of open cholecystectomy in the elderly: a longitudinal analysis of 21,000 cases in the prelaparoscopic era. Surgery. 1995; 117:156–164.

9. Sheridan WG, Williams HO, Lewis MH. Morbidity and mortality of common bile duct exploration. Br J Surg. 1987; 74:1095–1099.

10. Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D'Ambrosio G, Lezoche G, et al. Long-term results after laparoscopic transverse choledochotomy for common bile duct stones. Surg Endosc. 2005; 19:705–709.

11. Hacker KA, Schultz CC, Helling TS. Choledochotomy for calculous disease in the elderly. Am J Surg. 1990; 160:610–612.

12. Miller BM, Kozarek RA, Ryan JA Jr, Ball TJ, Traverso LW. Surgical versus endoscopic management of common bile duct stones. Ann Surg. 1988; 207:135–141.

13. Kullman E, Chu M, Svandik J, Borch K. Trends in diagnosis, management and outcome of common bile duct stones: a population-based study. Dig Surg. 1995; 12:92–97.

14. Roukema JA, Carol EJ, Liem F, Jakimowicz JJ. A retrospective study of surgical common bile-duct exploration: ten years experience. Neth J Surg. 1986; 38:11–14.

15. Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev. 2006; (2):CD003327.

16. Riciardi R, Islam S, Canete JJ, Arcand PL, Stoker ME. Effectiveness and long-term results of laparoscopic common bile duct exploration. Surg Endosc. 2003; 17:19–22.

17. Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg. 2010; 145:28–33.

18. Lu J, Cheng Y, Xiong XZ, Lin YX, Wu SJ, Cheng NS. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones. World J Gastroenterol. 2012; 18:3156–3166.

19. Rhodes M, Sussman L, Cohen L, Lewis MP. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998; 351:159–161.

20. Urbach DR, Khajanchee YS, Jobe BA, Standage BA, Hansen PD, Swanstrom LL. Cost-effective management of common bile duct stones: a decision analysis of the use of endoscopic retrograde cholangiopancreatography (ERCP), intraoperative cholangiography, and laparoscopic bile duct exploration. Surg Endosc. 2001; 15:4–13.

21. Freeman ML. Complications of endoscopic sphincterotomy. Endoscopy. 1998; 30:A216–A220.

22. Sand J, Airo I, Hiltunen KM, Mattila J, Nordback I. Changes in biliary bacteria after endoscopic cholangiography and sphincterotomy. Am Surg. 1992; 58:324–328.

23. Faylona JM, Qadir A, Chan AC, Lau JY, Chung SC. Small-bowel perforations rel ated to endos copic ret rog rade cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy. 1999; 31:546–549.

24. Sugiyama M, Suzuki Y, Abe N, Masaki T, Mori T, Atomi Y. Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy. Gut. 2004; 53:1856–1859.

25. Thompson MH, Tranter SE. All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg. 2002; 89:1608–1612.

26. Naraynsingh V, Hariharan S, Ramdass MJ, Dan D, Shukla P, Maharaj R. Open common bile duct exploration without T-tube insertion-two decade experience from a limited resource setting in the Caribbean. Indian J Surg. 2010; 72:185–188.

27. Seale AK, Ledet WP Jr. Primary common bile duct closure. Arch Surg. 1999; 134:22–24.

28. Sorensen VJ, Buck JR, Chung SK, Fath JJ, Horst HM, Obeid FN. Primary common bile duct closure following exploration: an effective alternative to routine biliary drainage. Am Surg. 1994; 60:451–454.

29. Uchiyama K, Onishi H, Tani M, Kinoshita H, Kawai M, Ueno M, et al. Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg. 2003; 238:97–102.