Laparoscopic Treatment of CBD Stones: "Single Stage" Laparoscopic Approach To Cholelithiasis And Choledocholithiasis
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Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance There are se..‘r:il disadvantages to ERCP including the additional invasiveness of endoscopic procedures. moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES (endoscopic sphincterotonly).The peroperative real time cholangiography has the advantage, of addressing choledocholithiasis with a single procedure LCBDE (Laparoscopic Common Bile Duct Exploration) while leaving the sphincter of Oddi anatomially intact without added morbidity. The choice of treatment between immediate laparoscopic common bd.: duct exploration, open exploration of CBD and trans-sphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and eNamine the biliary duct system by laparoscopic intra-operative cholangiography (IOC) during laparoscopic cholecystectomy (LC). The aim was to visualize the ductal anatomy and any anomalies on filling with contrast (to avoid biliary injury), detect any CBD stones and nssess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Methods: Intraoperative cholangiography was performed for 302 patients ulderwent LC for chronic calcular cholecystitis (CCC) in Benha University Hospital from Dec. 1999"to Jan. 2002. Results: Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patjelt-(11.3%) were harboring silent CBD stones managed immediately for CBD clarance. LCBDE was feasible in 23/31 cases who had choledecholithiasis (74.2%), while 8 patients needed conversion to open choledochotomy. 28 patients (9.3%) had preoperative :3RCP, endoscopic sphincterotomy (ES), stone retrieval and stenting. Operative cholangiography during LC proved residual stones in CBD in 2 of them (7.1%) and were treated by open choledoch,otorny while the other 26 patients were followed by stent extraction postoperatively. Conclusion: LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choled6cholithiasis as a "one step" procedure.