Abstracts
1997 Digestive Disease Week

Laparoscopic common bile duct exploration by choledochotomy.

JP Dorman, ME Franklin Jr, JL Glass.

From August, 1990, until August, 1996, we have used laparoscopic common bile duct exploration by choledochotomy (LCBDE-C) to approach biliary obstruction by choledocholithiasis and herein report our results. Over this time frame, we initially used preoperative ERCP when stones were suspected and postoperative ERCP when stones were found at laparoscopic cholecystectomy. Retained stones after ERCP found on intraoperative cholangiogram stimulated our interest in adapting the older open techniques of choledochotomy to laparoscopy.

In 1,885 cholecystectomies, we have encountered 132 cases with common bile duct stones, all of which underwent LCBDE-C. Our results were 123 successfully done by choledochotomy and four successfully done by transcystic approach - overall 127 of 132 (96% success rate). Five cases were converted to open for various reasons; three patients had retained stones requiring postoperative ERCP (2.2%) and one postoperative death occurred from acute myocardial infarction (0.7% mortality).

We conclude that management of choledocholithiasis, excluding the elderly with acute ascending cholangitis, should be by laparoscopic common bile duct exploration. Transcystic or choledochotomy approaches may be used, but the choledochotomy method has greatest utilitarian application to all stones located in both proximal and distal biliary tree.