Treatment of gallbladder stone with common bile duct stones in the laparoscopic era

BMC Surgery

Wen-xian Guan¹  Guo-zhong Wu²  Jie-ming Li²  Zhi-tao Dong²  Kun-lun Luo²  Qin Huang³  Gui-fang Xu⁴  Wei-jie Zhang¹ 

[1] Department of General Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, China;Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu 214044, China;Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, Massachusetts 02132, USA;Department of Gastroenterology, Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing 210008, China

关键词: Primary closure;    Choledochotomy;    Transcystic;    Common bile duct stones (CBDS);    Laparoscopic;    Cholecystectomy;   

Others  :  1121566
DOI  :  10.1186/1471-2482-15-7

 received in 2014-10-15, accepted in 2015-01-15,  发布年份 2015

【 摘 要 】

Background

Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients.

Methods

From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE. Intraoperative findings, postoperative complications, postoperative hospital stay and costs were analyzed.

Results

Because of LCBDE failure,16 cases (4.6%) required open surgery. Of 330 successful LCBDE-treated patients, 237 underwent LTSE and 93 required LC. No mortality occurred in either group. The bile duct stone clearance rate was similar in both groups. Patients in the LTSE group were significantly younger and had fewer complications with smaller, fewer stones, shorter operative time and postoperative hospital stays, and lower costs, compared to those in the LC group. Compared with patients with T-tube insertion, patients in the LC group with primary closure had shorter operative time, shorter postoperative hospital stay, and lower costs.

Conclusions

In cases requiring LCBDE, LTSE should be the first choice, whereas LC may be restricted to large, multiple stones. LC with primary closure without external drainage of the CBDS is as effective and safe as the T-tube insertion approach.

【 授权许可】

   
2015 Zhang et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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