Laparoscopic CBD exploration . our experience

Background: Common bile duct (CBD) stone is the strong indication for surgical therapy, especially in patients with obstructive jaundice. With the development of laparoscopic equipment and technology, laparoscopic common bile duct exploration (LCBDE) has been widely used in clinical practice. Many previous studies have demonstrated that LCBDE is less invasive than conventional open surgery and it permits single-stage management of CBD stone. The aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) through cholangiotomy with T-tube placement in management of common bile duct stones (CBDS). Patients and methods: A total of 17 patients who were diagnosed with concomitant choledocholithiasis and cholelithiasis have undergone LCBDE using a choledochotomy (CBD) from December 2014 to janauary2017. The choledochoscope was inserted into the lumen of the CBD, all CBD stones were retrieved using a basket or a Fogarty balloon catheter or were irrigated with saline. After CBD clearance was confirmed using the choledochoscope, the choledochotomy was closed with the bard absorbable suture material Results: total of 17 patients (12males and 5 females) were recruited; the mean patient age in the present study was 47.88 ± 14.7 years. Preoperative liver function tests were obtained on the day before surgery. The bilirubin level ranged from 0.28 to 6.47 mg/dl (mean 3.13 ± 2.50 mg/dl), and gallstone pancreatitis was present in three patients which were treated preoperatively in a conservative manner with fluid resuscitation and nutritional support; surgery was performed when the symptoms were relieved and laboratory result return to normal. In terms of disease characteristics, the diameter of the CBD ranged from 8 to 27 mm (mean 12.2 ± 4.2 mm), and the number of CBD stones ranged from 1 to 4. The size of the largest CBD stone in each case ranged from 5 to 27 mm (mean 9.6 ± 7.4 mm). The mean operative time was 108.88 ± 30.3 min, and the mean length of the postoperative hospital stay was 6.0 ± 4.6 days. In patients who had large stones (over 10 mm, we used stone forceps to fragment and retrieve the stones. No patient developed symptoms or clinical signs that could be interpreted as late stricture. Four patients were converted to open surgery due to bleeding, severe inflammation, problems with equipment, or difficulties in introducing the T-tube. At follow-up, ALT, AST, ALP, and bilirubin returned to normal in all patients. Apart from that, no imaging or reintervention was required for any of the patients. All patients recovered without any postoperative complications, except for 2 patients, one patient who developed postoperative pancreatitis and other patient develop biliary leakage and there were no recurrent stones. No death within 30 days after surgery was seen. Conclusions, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low. [Emad Abdullatif Daoud. Laparoscopic CBD exploration. our experience. J Am Sci 2017;13(7):56-62]. ISSN 1545-1003 (print); ISSN 2375-7264 (online). http://www.jofamericanscience. org. 6. doi:10.7537/marsjas130717.06.