A Study of Laparoscopic Common Bile Duct Exploration and Primary Closure in Haryana

Despite numerous reports showing the advantages of laparoscopic common bile duct exploration (LCBDE), many general surgeons, continue to rely heavily on endoscopic retrograde cholangiography with sphincterotomy (ERCP) to manage Common bile duct stones (CBDS). This study is aimed to evaluate the efficacy, safety and surgical outcome of LCBDE with primary closure of Common bile duct (CBD) when adopted as the preferred first-line management of CBDS stones by general surgeons.

In this retrospective study, 62 patients of choledocolithiasis during January 2011-December 2013 were taken up. Laparoscopic common bile duct exploration (LCBDE) with primary closure of Common bile duct (CBD) was performed in all these patients by a single laparoscopic surgeon (the author). The following parameters were analyzed: gender, age, weight, length of stay (LOS), underlying diseases, previous operation, operative time, duration of hospital stay, postoperative complications, including bile leakage, retained CBD stones, biliary peritonitis, subphrenic abscess and postoperative jaundice.

Laparoscopic CBDE were successfully performed in 62 patients without any conversion to open. Most of the patients (51.6%) presented with abdominal pain, while 37% had jaundice or deranged liver function tests and 6.5% patients had previously failed ERCP. Ultrasound (67%) was the most commonly adopted imaging modality to diagnose CBD stones. The average operative time was 65 minutes. The average LOS was 3 days. 8% of the patients had bile leak but it was not significant (<30ml/day). However, this was managed conservatively and no further intervention was required. Minor complications in our study included chest infections (3.2%) and wound infection (1.6%). None of the patients had retained stones.

The author has no doubt to conclude that laparoscopic CBDE with primary closure of CBD is feasible, practical, will become the procedure of choice in choledocholithiasis except in certain circumstances. It should be mastered by surgeons willing to perform more advanced and complex laparoscopic procedures.