Introduction. While laparoscopic cholecystectomy is considered the treatment of choice for symptomatic cholecystolithiasis, the management of common bile duct stones (CBDS) is still controversial. The treatment of choledocholithiasis since the development of laparoscopic cholecystectomy has often been ES combined with laparoscopic cholecystectomy in a two-stage procedure that adds the complications of both procedures.
The aim of this study was to evaluate effectiveness of laparoscopic choledochotomy compared to ERCP/ES for large retained stones.
Materials and methods. From September 1994 to June 2012 all patients who underwent a laparoscopic common bile duct stones extraction were included in a prospective study. They were managed in Odessa regional hospital. This series of 415 patients included 295 women and 120 men. The mean age was 64 years (range = 18–92). 321 patients were classified ASA I and ASA II and 94 were ASA III and ASA IV. Common bile duct stones were diagnosed or suspected preoperatively in 306 patients (73.8%) or identified at IOC in 109 patients (26.2%).
Results. A TCDE was attempted in 254 cases with success in 214 cases (51.5%). The main causes of failure were impacted stones and stones larger than 5 mm. The success rate was 97%. The overall success rate of laparoscopic treatment of CBDS was 96.2%. The mean operative time was 124 min (range = 40–360). It was 96 min in TCDE and 137 min in choledochotomy. The complication rate was 6.7%, including 3.9% of local complications and 2.8% of general complications and the mortality rate was 1%.
Conclusion. The laparoscopic management of CBDS has the advantage over ES followed by LC because it is a onestage procedure. The laparoscopic treatment of CBDS is particularly indicated in ASA I and ASA II patients because it is a safe procedure in terms of short-term outcome and late sequelae.