Laparoscopic management of patients with suspect of common bile duct stones

Abstract

Objective: To compare the effectiveness, security and costbenefit of laparoscopic treatment of patients with suspicion of biliar lithiasis versus endoscopic retrograde cholangiopancreatography (ERCP). This study was performed at the “Dr. Domingo Luciani” Hospital (Servicio de Cirugía II, Caracas). Patients and method: A comparative, prospective and controlled study executed between January and November of year
2009, about patient with extrahepatic cholestasis, arranged in two groups: patients with suspicion of biliar lithiasis treated with ERCP and subsequently laparoscopic cholecystectomy (group A), and patients with suspicion of biliar lithiasis treated with laparoscopic cholecystectomy (without previous realization of ERCP), intraoperative cholangiography and transcystic exploration of the common bile duct or choledochotomy approach (group B). Results: 13 patients were studied in group A and 8 in group B. In the first group, 8 patients were diagnosed with ERCP (biliar lithiasis) and 5 of them were successfully treated without surgery. In group B, 3 there were 3 patients with biliar lithiasis who were
successfully treated through common bile duct exploration after laparoscopic cholecystectomy without any complications. Conclusion: The laparoscopic exploration of the common bile duct has a similar efficiency to the ERCP, especially through transcystic approach. A single treatment attempt can be done through laparoscopic surgery without needing a second intervention after ERCP.