Original

J Minim Invasive Surg 2007; 10(1): 22-27

Published online June 30, 2007

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

거대 총담관 결석 환자에서 선택적으로 시행된 복강경 총담관 탐색술

김동희

을지대학교 을지병원 외과학교실

Selective Performed Laparoscopic Common Bile Duct Exploration for Patients with Large CBD Stones

Dong Hee Kim, M.D.

Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Although application of laparoscopic common bile duct exploration (LCBDE) has been growing, the initial treatment during recent decades for large common bile duct (CBD) stones has been endoscopic sphincterotomy (EST) or endoscopic papillary ballon dilatation (EPBD). However, performing EST or EPBD for patients with large CBD stones requires a prolonged time or repeated sessions for removal of large CBD stones. The aim of this study was to evaluate the clinical benefits of LCBDE for patients with large CBD stones. Methods: From January 2003 to December 2006, we conducted a retrospective study to compare LCBDE (n=37) with EST or EPBD (n=55) for the management of patients with large CBD stones that were more than 15 mm in maximum diameter. Result: All the LCBDEs were performed via choledochotomy with T-tube placement. The mean operation time was 134.1±15.7 minutes. The postoperative hospital stay was statistically shorter in the LCBDE (8.35±3.2 days) group than in the EST or EPBD (10.7±3.1 days) groups (p<0.003). The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (LCBDE, 1.1±0.1; EST or EPBD, 2.8±0.8; p<0.001). Only 2 patients (5.4%) required postoperative choledochoscopy to clear residual stones through the T-tube tract in the LCBDE group. The morbidity rate was not statistically different between the LCBDE group and the EST or EPBD groups (p>0.05). Conclusion: The above results suggested that LCBDE for patients with large CBD stones tended to require a shorter postoperative hospitalization and less sessions for complete removal of larger CBD stones than did endoscopic treatment.

Keywords Laparoscopy, Surgery, Common bile duct stones

Article

Original

J Minim Invasive Surg 2007; 10(1): 22-27

Published online June 30, 2007

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

거대 총담관 결석 환자에서 선택적으로 시행된 복강경 총담관 탐색술

김동희

을지대학교 을지병원 외과학교실

Selective Performed Laparoscopic Common Bile Duct Exploration for Patients with Large CBD Stones

Dong Hee Kim, M.D.

Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Although application of laparoscopic common bile duct exploration (LCBDE) has been growing, the initial treatment during recent decades for large common bile duct (CBD) stones has been endoscopic sphincterotomy (EST) or endoscopic papillary ballon dilatation (EPBD). However, performing EST or EPBD for patients with large CBD stones requires a prolonged time or repeated sessions for removal of large CBD stones. The aim of this study was to evaluate the clinical benefits of LCBDE for patients with large CBD stones. Methods: From January 2003 to December 2006, we conducted a retrospective study to compare LCBDE (n=37) with EST or EPBD (n=55) for the management of patients with large CBD stones that were more than 15 mm in maximum diameter. Result: All the LCBDEs were performed via choledochotomy with T-tube placement. The mean operation time was 134.1±15.7 minutes. The postoperative hospital stay was statistically shorter in the LCBDE (8.35±3.2 days) group than in the EST or EPBD (10.7±3.1 days) groups (p<0.003). The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (LCBDE, 1.1±0.1; EST or EPBD, 2.8±0.8; p<0.001). Only 2 patients (5.4%) required postoperative choledochoscopy to clear residual stones through the T-tube tract in the LCBDE group. The morbidity rate was not statistically different between the LCBDE group and the EST or EPBD groups (p>0.05). Conclusion: The above results suggested that LCBDE for patients with large CBD stones tended to require a shorter postoperative hospitalization and less sessions for complete removal of larger CBD stones than did endoscopic treatment.

Keywords: Laparoscopy, Surgery, Common bile duct stones

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