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. |
