The management of combined gallstones and CBD stones should include removal of thegallbladder and clearance of the duct system which can be achieved by ERCP and extraction of stones before operation or directly with laparoscopic cholecystectomy (LC) and laparoscopic common duct exploration (LCDE). LCDE can be done under fluoroscopic or choledochoscopic guidance. Choledochoscopy provides the ultimate in visualization and control of CBD manipulations. LCDE is well accepted by patients because treatment is obtained during the same anesthesia.
To assess the technical feasibility and potential advantages of LCDE and address the accuracy of choledochoscopy in the diagnosis and clearance of CBD stones.
Patients & methods:
From March 2011 to October 2014, 30 patients with CBD stones were prospectively treated by LC and LCDE at Department of Surgery, Sohag University, Upper Egypt.
This study included 28 females and 2 males, age ranged from 25-85 years. 25 patients were presented by biliary colic (16 of them had subclinical jaundice) and 5 with jaundice. Mean CBD diameter was 13.3 (range 8-25) mm. CBD stones were single in 20 cases, double in 2 and multiple in 8. Direct choledochotomy approach was performed in 27 patients and transcystic approach in 3. The choledochoscope was used in all cases. Successful clearance of stones was achieved laparoscopically by combination of wash, Dormia basket and balloon extraction in 27 patients, 3 were converted to open. Closure of CBD was done over T-tube in 17 cases and primarily in 10. Mean operative time was 127 (range 90-210) minutes. No intra-operative complications. Post-operative complications occurred only in 3 cases (3 biliary leakages & one localized intra-peritoneal collection). No mortality. Mean hospital stay was 8.4 (range 5-15) days. No residual or recurrent CBD stones during the systematic follow-up until February 2015.
LCDE during LC solves 2 problems during the same anesthesia with high success and low morbidity and mortality rates. The choledochoscopy has high diagnostic and therapeutic accuracy during laparoscopic choledocholithotomy..