Publication By Dr Liau Kui Hin and Dr Ho C.K. - Laparoscopic Surgery

Laparoscopic exploration can salvage failed

endoscopic bile duct stone extraction

Vishal G Shelat, MRCSE, MMed, Chung Yip Chan, MD, FRCS, Kui Hin Liau, FRCS, FAMS, Choon Kiat Ho, FRCS, FAMS

Introduction

Conventionally, patients who failed endoscopic removal of common bile duct stones (CBDS) by

endoscopic retrograde cholangiopancreaticography (ERCP) would be treated with open cholecystectomy and common

bile duct exploration. Laparoscopic common bile duct exploration (LCBDE) is an established option for treating CBDS. The

aim of this paper was to look at the feasibility of LCBDE as a salvage procedure after failed endoscopic stone extraction

(ESE). The secondary endpoint was to examine the short-term outcomes of our LCBDE series.

Methods

We retrospectively reviewed a prospective database to study the feasibility of LCBDE as a salvage procedure

for failed ERCP.

Resu lts

Since its inception in 2006, 43 patients had undergone LCBDE at our centre. This was achieved via a

transcystic approach in 25 patients and laparoscopic choledochotomy in 15 patients. There were three conversions. Of

these 43 patients, 21 had a pre-operative attempt at ESE, but only six patients had their ducts cleared endoscopically.

The 15 patients who failed ESE underwent LCBDE, of which 14 achieved successful stone clearance and one required

open conversion. One patient developed a bile leak, which resolved spontaneously. The median length of stay (LOS) for

these 15 patients was three days, while the median LOS for the whole cohort was two days.

Conclusion

LCBDE has been shown to be a safe and effective method for treating CBDS, with the added bonus of a

short hospital stay. Where the expertise is available, LCBDE is a safe option as a salvage procedure for failed ESE.

Keywords: bile duct exploration, cholecystectomy, common bile duct stones, endoscopic stone extraction, laparoscopy

Singapore Med J 2012; 53(5): 313–317