Laparoscopic common bile duct exploration

Objective: To explore the feasibility of laparoscopic techniques for the removal of common bile duct (CBD) stones. Design: Retrospective analysis. Setting: University hospital, Sweden. Subjects: 39 patients who underwent laparoscopic common bile duct exploration, either by a transcystic technique or by choledochotomy, between September 1992 and April 1995. Interventions: Cholecystectomy, intraoperative cholangiography, and removal of CBD-stones by a transcystic technique (n = 22), laparoscopic choledocholithotomy (n = 11), or after conversion to open choledocholithotomy (n = 6). Main outcome measures: Stone clearance rates, operative time, complications, and postoperative hospital stay. Results: Stone removal was achieved in 32/39 patients (82%) by a laparoscopic approach. Reasons for failure were early in our experience, and the result of technical difficulties or stones that were too large for the transcystic approach, or with impacted stones at choledochotomy. Postoperative morbidity was low (n = 4, 10%) with no mortality. Conclusions: Common bile duct stones can be removed in a large proportion of patients undergoing laparoscopic cholecystectomy, either by a laparoscopic transcystic technique or through a laparoscopic choledochotomy. The laparoscopic techniques need further evaluation, preferably in prospective multicentre trials comparing other treatment strategies including endoscopic sphincterotomy.