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Results of laparoscopic bile duct exploration via choledochotomy
Author(s) -
Kelly Michael D.
Publication year - 2010
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2010.05269.x
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , surgery , bile duct , interquartile range , lithotripsy , endoscopy , pancreatitis
Background: Laparoscopic bile duct exploration (LBDE) is well established although the results via choledochotomy are relatively poorly documented. This report evaluates the results achieved by a single surgeon operating in one institution on an unselected group of patients using modern instrumentation. Methods: Over a 3‐year period, 56 consecutive patients underwent LBDE via choledochotomy utilizing flexible choledochoscopy. Results: The median age was 61 years (range 20–90) and the mean body mass index was 29 (21–47). There were 15 patients (27%) who had emergency operations for jaundice with a mean preoperative bilirubin level of 108 umol/L (41–248). Fourteen patients (25%) had undergone failed preoperative endoscopic retrograde cholangiopancreatography. Contact electrohydraulic lithotripsy was used in 8 patients (14%) and t‐tubes were inserted in 6 patients (11%) with the remainder having primary closure. There was major morbidity in 6 patients (11%) including conversion to open surgery in 1 and relaparoscopy in 3. Three patients had positive t‐tube cholangiograms giving a laparoscopic clearance rate of 93% (52 patients). The median postoperative length of stay was 2.5 days (1–15). The median follow‐up was 56.1 weeks (interquartile range 23.4–110.7) with no recurrent stones, strictures or late gallstone abscess. Conclusions: LBDE via choledochotomy is safe and effective but there is a definite morbidity rate. It requires significant investment in equipment, and skill with flexible endoscopy and laparoscopic suturing.