Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at
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and Other Interventional Techniques
Lessons learnt from the first 200 unselected consecutive cases of laparoscopic exploration of common bile duct stones at a district general hospital Mahmoud Al‑Ardah1 · Rebecca E. Barnett2 · Simon Morris1 · Tarig Abdelrahman2 · Michael Nutt1 · Tamsin Boyce1 · Ashraf Rasheed1 Received: 17 July 2020 / Accepted: 21 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt. Methods We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes. Results We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture. Conclusion Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients. Keywords Common bile duct exploration · Common bile duct clearance · Transcystic · Choledocholithiasis Choledocholithiasis is present in approximately 10–15% of patients with gallstones [1, 2]. This proportion may reach 15–60% in elderly patients [3], making it a common problem to manage by both surgeons and endoscopists. The management of choledocholithiasis remains a challenge, despite progress in instrumentation and technology and
* Mahmoud Al‑Ardah [email protected] 1
Gwent Centre for Digestive Diseases, Royal Gwent Hospital, Newport NP20 2UB, UK
Department of General Surgery, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
2
advancement in endoscopic and laparoscopic skills with no universal consensus on the best therapeutic approach. The significan
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