LAPAROSCOPIC TREATMENT OF MAIN BILE DUCT STONES – SINGLE CENTER EXPERIENCE
Up to 20% of the patients with gallstones have bile duct stones which are asymptomatic in 50% of the cases. The study aimed to evaluate the role of choledocoscopy with regards to extracting main bile duct stones. Retrospective study (January 2003 - December 2018). The group comprised 2 309 which had a laparoscopic cholecystectomy. Results: Laparoscopic choledoscopy was practiced in 32 cases. Of the 32 patients with complete clearance, none had residual CBDS at a 1-year postop. Transcystic approach: The ideal approach in our opinion. Shortest hospital stay (mean 3 days) comparable to LC. It was feasible in only 7 patients. All of the patients had transcystic drain which was removed after 10 days. Mean OR time 105 min. Transcholedocal approach: Technically demanding. Primary ductal closure was practiced in 5 patients. Ductal closure with transcystic drain in 9 patients. A total of 14 patients had a T-tube. Longer OR time (mean 170 min). Conversion to open surgery was realized in 4 cases. Cause: difficult dissection in the porta hepatis. LCBDE for CBDS previously documented or discovered during LC is safe and feasible. The technique is technically demanding, requires advanced laparoscopic skills. Patient selection is very important. The transcystic approach for LCBDE when possible is optimal.