Laparoscopic management of common bile duct stones

• Published in: Tando Vol. 26; no. 1; pp. 40 - 45
• Main Authors: Nomura, Ryouhei, Matsumura, Naoki, Tokumura, Hiromi
• Format: Journal Article
• Language: Japanese
• Published: Japan Biliary Association 2012; 一般社団法人 日本胆道学会
• Subjects: C-tube drainage; choledochotomy; common bile duct stones; Cチューブ; laparoscopic cholecystectomy; transcystic method; 経胆嚢管法; 総胆管結石症; 胆管切開; 腹腔鏡下手術
• ISSN: 0914-0077; 1883-6879
• DOI: 10.11210/tando.26.40

The optimal management of patients with concomitant common bile duct (CBD) stones and gallstones is still evolving. Since May 1992 we have begun laparoscopic common bile duct (CBD) exploration as the choice for the management of CBD stones. Laparoscopic CBD exploration is actually categorized into two approaches which are the transcystic approach and choledochotomy. We selected the transcystic approach for patients whose CBD stones were less than 4 in number and smaller than 8 mm in diameter on cholangiograms. Among 515 patients with CBD stones, the transcystic approach was performed successfully in 205 cases. 300 patients underwent laparoscopic choledochotomy which was followed by ductal closure with transcystic drainage in 177, T-tube drainage in 75, primary ductal closure in 31, and others. Ten patients were converted to open surgery. The transcystic approach was associated with short hospital stay and few morbidities. Choledochotomy also had an acceptably low rate of complications and short hospital stay especially with C-tube drainage. Bile leaks occurred more frequently in those with primary ductal closure than in those with transcystic drainage or T-tube drainage. From these results we conclude that laparoscopic management of CBD stones is feasible for almost all cases of CBD stones. In the near future, the procedure should be the choice for CBD stones.