Laparoscopic choledochotomy is required in certain situations. It is required whenever a transcystic approach fails.
Biliary drainage after choledochotomy has a 5% morbidity rate. Therefore the avoidance of biliary drains might improve the results of laparoscopic common bile duct exploration (LCBDE).
In this study, researchers from France performed an evaluation of laparoscopic choledochotomy, with completion choledochoscopy and primary duct closure without any biliary drainage.
The research team assessed 100 patients, from 4 surgical centers, who underwent this procedure between 1991 and 1997.
Choledocholithiasis was demonstrated preoperatively in 35 patients, suspected in 52, and found during routine intraoperative cholangiography in 13.
|Common bile duct vacuity was achieved in all patients without mortality.|
External ultrasound was the only preoperative imaging investigation in 87 patients.
The team attempted LCBDE irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of common bile duct (CBD) stones.
The researchers found that the technique was equally feasible in all the participating centers.
Vacuity of the CBD was achieved in all patients without mortality.
However, 11 patients had complications, and 3 required a laparoscopic reintervention.
The team determined that the median postoperative hospital stay was 6 days.
No patient required additional CBD procedures during follow-up.
Dr Decker’s team concluded, “In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD”.
“This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.”