Purpose : Laparoscopic common bile duct exploration (LCBDE) has more advantages thanconventional common bile duct surgery, but the use ofthis route for stone removal and biliarydrainage remains controversial. The goal of this study was to investigate the usekilness ofLCBDE in patients who had been failed in the endoscopic stone extraction.
Methods : From November 2005 to August 2008, 52 patients underwent LCBDE due tofailure of endoscopic stone extraction in Chungnam National University Hospital. Clinical datawere collected and analyzed retrospectively.
Results : Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure ofendoscopic stone extraction and large common bile duct stone 12 cases (23.1%), Previousupper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did nothave preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients(86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resultedin open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3cases of stone impaction in ampulla portion, and 1 case of a remnant stone. Extemal biliarydrainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD (7 cases, 15.6%),ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone weredetected in 2 cases (4.4%) and removed with choledochoscope via external biliary drain.Postoperative complications happened in 5 cases (9.5%). Procedure related complicationshappened in 2 cases (3.8%).
Conclusion : LCBDE is useful technique in patients with failed endoscopic stone extraction,and biliary drainage may be necessary for detection and removal of latent remnant CBDstones.
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