Michael D Kelly1. 1. Department of Upper GI Surgery, North Bristol NHS Trust, Bristol, UK. michael.kelly@nbt.nhs.uk
Abstract
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 10 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.
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 10 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.
Authors: Carlos Augusto Gomes; Cleber Soares Junior; Salomone Di Saverio; Massimo Sartelli; Michael Denis Kelly; Camila Couto Gomes; Felipe Couto Gomes; Lívia Dornellas Corrêa; Camila Brandão Alves; Samuel de Fádel Guimarães Journal: World J Gastrointest Surg Date: 2017-05-27