Management of common bile duct stones; LCBDE feasibility, and prospective to substitute combined ERCP/lap. Chole.

Abstract

Purpose: A prospective work to study laparoscopic common bile duct exploration (LCBDE), its detailed techniques used with assessment of CBD clearance in comparison to conventional surgery and endoscopic techniques used in equal number of patients to discuss its feasibility, assess all difficulties encountered, and evaluate its prospective to substitute combined ERCP-Laparoscopic cholecystectomy procedure.

Patients & Methods: A random sample of 50 cases of chronic calcular cholecystitis plus CBD stone(s) were enrolled, and treated by laparoscopic cholecystectomy plus choledocholithotomy with assessment of CBD clearance by choledochoscope in 30 patients, and cholangiogram in 15 patients

Results: Fifty patients were enrolled in this study (32 females and 18 males), all having CBD stones and assigned for laparoscopic management. Trans cystic approach was done in 5 cases only (10%), however trans choledochotomy was done for 45 cases (90%). Mean operative time was 111 min. with 98% success of attempted procedures (2% failure with conversion), and 98% CBD clearance rate (2 cases of missed stone). No mortality encountered but post procedural morbidity of 10% was encountered in the form of hypothermia, fever, hyperamylasemia, and missed stone. Mean hospital stay was 3.5 days, and return to work was 7days 

Conclusion: LCBDE approach is feasible promising minimal access technique, with no mortality, low morbidity results. But requires high skills experienced team, up-to-date equipment's, and good selection of patients. The association between LCBDE and intra-operative cholangiogram has high CBD clearance rate which was not achieved by choledochoscope approaches. It is advised to carryon its role on a greater scale of cases to gain a consensus, however ERCP-Laparoscopic cholecystectomy still in use especially in normal biliary diameter, small stone size, multiple stones, and stone impaction in the ampullary  part, Experience influence treatment and it is mandatory with other facility and equipment for management of such cases.