Skip to main content

Advertisement

SpringerLink
Log in

A balanced approach to choledocholithiasis

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We set out to review and evaluate the results of an algorithm for managing choledocholithiasis in patients undergoing laparoscopic cholecystectomy.

Methods

We performed retrospective review of patients with choledocholithiasis at the time of laparoscopic cholecystectomy (LC) between March 1993 and August 1999. All patients were operated on under the direction of one surgeon (M.E.A), following a consistent algorithm that relies primarily on laparoscopic transcystic common bile duct exploration (TCCBDE) but uses laparoscopic choledochotomy (LCD) when the duct and stones are large or if the ductal anatomy is suboptimal for TCCBDE. Intraoperative endoscopic retrograde sphincterotomy (ERS) is done if sphincterotomy is required to facilitate common bile duct exploration (CBDE). Postoperative endoscopic retrograde cholangiopancreatography (ERCP) is utilized when this fails. Preoperative ERCP is used only for high-risk patients.

Results

A total of 728 LC were performed, and there were 60 instances (8.2%) of choledocholithiasis. Primary procedures consisted of 47 TCCBDE; 37 of them required no other treatment. In five cases, the stones were flushed with no exploration. Intraoperative ERS was performed three times as the only form of duct exploration. LCD was utilized twice; one case also required intraoperative ERS, and the other had a postoperative ERCP for stent removal. One patient with small stones was observed, with no sequelae. Preoperative ERCP was done twice as the primary procedure. Of the 10 cases that were not completely cleared by TCCBDE, three had a postoperative ERCP and seven had an intraoperative ERS, one of which required a postoperative ERCP. There were three complications (6%) related to CBDE, with no long-term sequelae. There were four postoperative complications (6.7%) and no deaths. The mean number of procedures per patient was 1.12. The average postoperative hospital stay was 1.8 days (range, 0–14).

Conclusions

Choledocholithiasis can be managed safely by laparoscopic techniques, augmenting with ERCP as necessary. This protocol minimizes the number of procedures and decreases the hospital stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arregui ME, Davis CJ, Arkush AM, Nagan RF (1992) Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and Electro Hydrolic Lithotripsy for management of cholelithiasis with choledocholithiasis. Surg Endosc 6: 10–15

    Article  CAS  PubMed  Google Scholar 

  2. Arregui ME, Naverrete JL, Davis CJ, Hammond JC, Barteau J (1994) The evolving role of ERCP and laparoscopic common bile duct exploration in the era of laparoscopic cholecystectomy. Int Surg 79: 188–194

    CAS  PubMed  Google Scholar 

  3. Basso N, Gennaro P, Desdemona S, Materia A, Silecchia G, Fantini A, Fiocca F, Trentino P (1999) Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment of cholecystocholedocholithiasis. Gastrointest Endosc 50: 532–535

    Article  CAS  PubMed  Google Scholar 

  4. Berthou JC, Douard F, Charbonneau P, Moussalier K (1998) Evaluation of laparoscopic management of common bile duct stones in 220 patients. Surg Endosc 12: 16–22

    Article  CAS  PubMed  Google Scholar 

  5. Crawford DL, Phillips EH (1999) Laparoscopic common bile duct exploration. World J Surg 23: 343–349

    Article  CAS  PubMed  Google Scholar 

  6. DePaula AL, Hashiba K, Bafutto M (1994) Laparoscopic management of choledocholithiasis. Surg Endosc 8: 1399–1403

    CAS  PubMed  Google Scholar 

  7. Dorman JP, Franklin ME, Glass JL (1998) Laparoscopic common bile duct exploration by choledochotomy: an effective and efficient method of treatment of choledocholithiasis. Surg Endosc 12: 926–928

    Article  CAS  PubMed  Google Scholar 

  8. Gigot JF, Navez B, Etienne J, Cambier E, Jadoul P, Kestens PJ (1997) A stratified itraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones. Surg Endosc 11: 722–728

    Article  CAS  PubMed  Google Scholar 

  9. Giurgiu DI, Margulies DR, Carroll BJ, Gabbay J, Iida A, Takagi S, Fallas MJ, Phillips EH (1999) Laparoscopic common bile duct exploration: long-term outcome. Arch Surg 134: 839–844

    Article  CAS  PubMed  Google Scholar 

  10. Graham SM, Flowers JL, Scott TR, Bailey RW, Scovill WA, Zucker KA, Imbembo AL (1993) Laparoscopic cholecystectomy and common bile duct stones. Ann Surg 218: 61–67

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Johnson AS, Ferrara JJ, Steinberg SM, Gassen GM, Hollier LH, Flint LM (1993) The role of endoscopic retrograde cholangiopancreatography: sphincterotomy versus common bile duct exploration as a primary technique in the management of choledocholithiasis. Am Surg 59: 78–84

    CAS  PubMed  Google Scholar 

  12. Liberman MA, Phillips EH, Carroll BJ, Fallas MJ, Rosenthal R, Hiatt J (1996) Cost-effective management of complicated choledocholithiasis: laparoscopic transcystic duct exploration or endoscopic sphinterotomy. J Am Coll Surg 182: 488–494

    CAS  PubMed  Google Scholar 

  13. Martin IJ, Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228: 29–34

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Meyer C, Le JV, Rohr S, Thiry LC, Duclos B, Reimund JM, Baumann R (1999) Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative sphincterotomy. Surg Endosc 13: 874–877

    Article  CAS  PubMed  Google Scholar 

  15. Ng T, Amaral JF (1999) Timing of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy in the treatment of choledocholithiasis. J. Laparendosc Surg 9: 31–37

    CAS  Google Scholar 

  16. Paganini AM, Lezoche E (1998) Follow-up of 161 unselected consecutive patients treated laparoscopically for common bile duct stones. Surg Endosc 12: 23–29

    Article  CAS  PubMed  Google Scholar 

  17. Petelin JB (1993) Treatment of choledocholithiasis: laparoscopic approach to common duct pathology. Am J Surg 165: 487–491

    Article  CAS  PubMed  Google Scholar 

  18. Petelin JB (1999) Laparoscopic common bile duct exploration: transcystic duct approach. In: Scott-Connor CEH (ed) The SAGES manual: fundamentals of laparoscopy and GI endoscopy. Springer, New York Berlin Heidelberg, pp 167–177

    Chapter  Google Scholar 

  19. Phillips EH, Carroll BJ, Pearlstein AR, Daykhovsky L, Fallas MJ (1993) Laparoscopic choledochoscopy and extraction of common bile duct stones. World J Surg 17: 22–28

    Article  CAS  PubMed  Google Scholar 

  20. Thompson DM, Arregui ME, Tetik C, Madden MT, Wegener M (1998) A comparison of laparoscopic ultrasound with digital fluorocholangiography for detecting choledocholithiasis during laparoscopic cholecystectomy. Surg Endosc 12: 929–932

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, St. Vincent Hospital and Health Care Center, 8402 Harcourt Road, 46260, Indianapolis, IN, USA

    M. C. Lilly & M. E. Arregui

Authors
  1. M. C. Lilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. E. Arregui
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Online publication: 13 March 2001

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lilly, M.C., Arregui, M.E. A balanced approach to choledocholithiasis. Surg Endosc 15, 467–472 (2001). https://doi.org/10.1007/s004640080020

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004640080020

Key words

Search

Navigation