Preliminary Experience using Laparoscopic Transcystic Cholangioscopy for Treatment of Common Bile Duct Stones

Abstract

Laparoscopic transcystic cholangioscopy (LTC) in combination with electrohydraulic lithotripsy may be an alternative treatment to ERCP and sphincterotomy in patients with both gallbladder and common bile duct stones undergoing laparoscopic cholecystectomy. Preliminary experience using LTC lithotripsy in 13 cases is reported. In 12 cases the stones were pushed out into the duodenum using the tip of the cholangioscope, in 8 of them stone disintegration via LTC lithotripsy also being required. In the remaining case the cholangioscope could not be inserted into the common bile duct via the cystic duct due to complete cystic duct obstruction. The average hospital stay was 9 days (range 6-16) in patients with LTC/lithotripsy, which did not differ significantly from 8.4 days (range, 4-19) (n = 330) in the group undergoing laparoscopic cholecystectomy alone. The patients usually resumed normal activity the day after discharge. LTC lithotripsy has the advantages over endoscopic sphincterotomy of a shorter treatment and preservation of a normal functioning sphincter of Oddi. Further technical improvements, especially the development of a cholangioscope for this purpose, are urgently required.