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KMID : 0978820070100010022
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2007 Volume.10 No. 1 p.22 ~ p.27
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Selective Performed Laparoscopic Common Bile Duct Exploration for Patients with Large CBD Stones
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Kim Dong-Hee
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Abstract
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Purpose: Although application of laparoscopic common bile duct exploration (LCBDE) has been growing, the initial treatment during recent decades for large common bile duct (CBD) stones has been endoscopic sphincterotomy (EST) or endoscopic papillary ballon dilatation (EPBD). However, performing EST or EPBD for patients with large CBD stones requires a prolonged time or repeated sessions for removal of large CBD stones. The aim of this study was to evaluate the clinical benefits of LCBDE for patients with large CBD stones.
Methods: From January 2003 to December 2006, we conducted a retrospective study to compare LCBDE (n=37) with EST or EPBD (n=55) for the management of patients with large CBD stones that were more than 15 mm in maximum diameter.
Result: All the LCBDEs were performed via choledochotomy with T-tube placement. The mean operation time was 134.1±15.7 minutes. The postoperative hospital stay was statistically shorter in the LCBDE (8.35±3.2 days) group than in the EST or EPBD (10.7±3.1 days) groups (p＜0.003). The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (LCBDE, 1.1±0.1; EST or EPBD, 2.8±0.8; p＜0.001). Only 2 patients (5.4%) required postoperative choledochoscopy to clear residual stones through the T-tube tract in the LCBDE group. The morbidity rate was not statistically different between the LCBDE group and the EST or EPBD groups (p＞0.05).
Conclusion: The above results suggested that LCBDE for patients with large CBD stones tended to require a shorter postoperative hospitalization and less sessions for complete removal of larger CBD stones than did endoscopic treatment.
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KEYWORD
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Laparoscopy, Surgery, Common bile duct stones
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