Purpose: To compare a laparoscopic common bile duct exploration to open method for the treatment of CBD stones and analogize the relative contraindication of laparoscopic surgery.
Methods: Retrospective study was performed of 71 patients who underwent common bile duct exploration for CBD stones at Presbyterian Medical Center, Jeon-Ju from April 1998 to June 2003. The patients were divided into three groups; a group treated by open choledocholithotomy (group OC, n=35), a group treated by laparoscopic choledocholithotomy (group LC, n=30), a group treated by conversion choledocholithotomy from laparoscopic surgery to open method (group CC, n=6).
Results: The mean operating time was longer in group LC than group OC (128.6 minutes in group OC, 199.8 minutes in group LC, 187.5 minutes in group CC)(p＜0.05). The postoperative hospital stay was shorter in group LC than the others (13.5 days in group OC, 9.6 days in group LC, 15.8 days in group CC)(p＜0.05). The clearance of CBD stone were 94.3% in group OC, 96.7% in group LC, 100% in group CC. The conversion rate of laparoscopic surgery to open method was 16.7%. The postoperative complication were 42.9% in group OC, 20% in group LC, 66.7% in group CC. There were no mortality in three groups. The cause of conversion choledocholithotomy was one of the following: (1) severe adhesion due to past upper abdominal surgery (4 cases), (2) combined other pathology (1 case), (3) long time procedure due to large and impacted stone (1 case). The cause of long time procedure of laparoscopic surgery (more than 3 hours) was one of the following: (1) large and impacted stone (8 cases), (2) multiple stones (4 cases), (3) severe adhesion (2 cases), (4) GB empyema (2 cases), (5) technical problem (1 case), (6) others (2 cases).
Conclusion: The laparoscopic common bile duct exploration is useful and safe method for the treatment of CBD stone. Relative contraindication of laparoscopic common bile duct exploration is following: (1) history of upper GI surgery, (2) difficulty to discriminate other pathology, (3) large and impacted stone, (4) multiple stone, (5) GB empyema, (6) inexperienced laparoscopic surgeon, (7) concomitant intrahepatic duct stone. Inspite of no absolute contraindication for laparoscopic common bile duct exploration, we need adequate selection criteria.
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