Publication:

Alternative laparoscopic techniques for stone extraction during laparoscopic CBD exploration: pros and cons

Background A prospective work to study various laparoscopic techniques used for stone extraction during laparoscopic common bile duct exploration (LCBDE) with assessment of CBD clearance by each technique with discussion of its feasibility and difficulties.

Methods Patients with chronic calcular cholecystitis with CBD stone(s) were treated randomly by laparoscopic cholecystectomy plus choledocholithotomy. Various methods were used for stone extraction either through the scope technique, direct access technique, or irrigation/suction technique. Assurance of CBD clearance of stones was done later using intra-operative choledochoscopy, cholangiogram, or post operatively using sonography or MRCP.

Results Out of sixty seven patients, laparoscopic CBD stone extraction was done through scope control in 25 patients, direct access technique in 22 patients, while irrigation/suction technique was done in 20 cases. Choledochoscope method was the most effective method for CBD clearance with success rate (96%), it was effective in distal CBD stones of average size (0.5-1.0 cm), and number (1-5), but unfortunately missed stone is a relative risk (4%). Direct access technique is as effective blindly especially if associated with irrigation/suction with success rate (81.8%) specially in non-impacted single distal stone of average size (0.5-1.0 cm) well recognized by MRCP a night before operation. Irrigation / suction technique was the least effective with success rate (50%) only with the need to convert to other technique in 50% of cases.

Conclusions Choledocoscope guided stone extraction technique was the technique of choice for CBD clearance during LCBDE.