Clinical evaluation of laparoscopic exploration of the common bile duct

Although laparoscopic cholecystectomy has became the gold standard for the management of gallstone disease, the application of laparoscopic common bile duct exploration (LCBE) for the treatment of choledocholithiasis has been slower.The aim of this study is to determine the feasibility and effectiveness of (LCBE).
Method: This study was carried out from October 2005 to March 2008 in Zagazig University Hospital on 32 patients (21 female 65.6% and 11 male 34.4%) with CBD and gallbladder stones who have undergone laparoscopic cholecystectomy and  CBD exploration. Transcholedochal laparoscopic common bile duct exploration was used in all patients with placement of T-tube in 17 patients and primary closure of CBD in 11 patients after assessing the clearance of CBD by choledochoscope.
Results: Mean operative time was 128 ± 31.2 minutes. The mean postoperative hospitalization was 2.2 ± SD 0.5 days, range 2-4 days in the patients with primary closure of CBD, but in the patients in whom the choledochotomy was closed over T-tube, the mean postoperative hospitalization was 5.4 ± SD 1.2 days, range 3-8 days (significant difference P<0.05). Conversion of the laparoscopic procedure to conventional open CBD exploration occurred in 4 patients (12.5%); due to sever adhesions present in the Calots triangle and the bile duct could not be visualized properly in 2 patients and due to impacted stones in the other 2 patients. Biliary leakage after surgery occurred in 3 patients (17.6%) after removal of T-tube who were treated conservatively for 4 to 5 days, and biliary leakage occurred only in one patient (9%) with primary closure of CBD and were treated by ERCP and billiary stent. Minor wound infection occurred in 2 (11.7%) of the patients in whom the choledochotomy was closed over T-tube, but such complications did not occurr in patients with primary closure of CBD. Mean time to return to normal activity was 9.2 ± 2.5 days in patients with primary closure of CBD, but 15.4 ± 3.5 days in patients where the choledochotomy was closed over T-tube (significant difference P<0.05). No stone recurrence was detected after a mean follow up period of 21 months ± 8.7, range 6-29 months.
Conclusion: Laparoscopic exploration of the CBD is highly successful, safe, feasible and single stage option for management of calcular cholecystitis with CBD stones, it also has the advantage of leaving the sphincter of Oddi anatomically intact. Primary closure after CBD exploration is as safe as T-tub drainage