Abstract
Background and Study Aims: Despite the documented success rate and safety of laparoscopic ductal stone extraction,
the majority of patients are treated with pre-operative endoscopic stone extraction
followed by laparoscopic cholecystectomy. When this fails, conventional open cholecystectomy
and common bile duct exploration are performed. We report here a series of patients
who were treated laparoscopically after failed attempts at endoscopic stone extraction.
Patients and Methods: Nineteen patients (12 women and seven men, aged 41-96 years) were treated laparoscopically.
Four had undergone previous cholecystectomy. ERCP had been attempted in all patients,
was unsuccessful in three patients, and had been interpreted as normal in two. Endoscopic
stone extraction had been attempted in 14 patients. The mean follow-up period was
23 months, range 1-54 months.
Results: Ductal calculi were confirmed in 18 patients with successful and complete laparoscopic
ductal clearance in 15 (83 %), two of whom underwent an additional laparoscopic choledochoduodenostomy
due to a large stone load and a grossly dilated common bile duct. Conversion to open
surgery was required in three cases (17 %). Ductal clearance at a single operation
was achieved in all 18 patients. There were no postoperative deaths, but two patients
developed postoperative complications (11 % morbidity), one requiring laparotomy.
The median postoperative hospital stay was five days, range 4-41 days. Recurrence
of calculi was encountered in one patient.
Conclusions: Laparoscopic ductal stone clearance after failed endoscopic stone extraction is successful
in the majority of patients, and should be attempted prior to recourse to open surgery,
provided the necessary laparoscopic biliary expertise is available.
