Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Abstract

Introduction. In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series. Methods. One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required. Results. Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy. Conclusions. Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique.

Direct visualisation of common bile duct during laparoscopic treatment of choledocholithiasis

“…al operated 46 patients due to cholelithiasis and choledocholithiasis with laparoscopic approach. [6] They performed transverse choledochotomy and T-tube drainage. Among all patients with 17 year follow up, ductal stone recurrence occurred in one case (2.1%) and managed by ERCP with endoscopic sphincterotomy.…”

How to perform laparoscopic common bile duct exploration through a transverse choledochotomy

“…The transcystic approach is less effective at clearing stones 6 . Factors, such as the degree of inflammation in Calot's triangle, the presence of multiple, large or impacted stones, and a narrow cystic duct, favour a transcholedochal approach 7 …”

“…6 Factors, such as the degree of inflammation in Calot's triangle, the presence of multiple, large or impacted stones, and a narrow cystic duct, favour a transcholedochal approach. 7 Choledochotomy can be completed longitudinally or transversely. 7 Longitudinal incision likely gained popularity to facilitate rigid instrumentation of the duct, which is no longer necessary.…”

“…7 Choledochotomy can be completed longitudinally or transversely. 7 Longitudinal incision likely gained popularity to facilitate rigid instrumentation of the duct, which is no longer necessary. The risk of ischaemic stricture following transverse choledochotomy is minimal, given that the 3 and 9 o'clock marginal vessels on the duct are not damaged.…”

Postcholecystectomy syndrome: a case report

“…In the face of greater success rates with the procedure, approximately 10-20% of the patients report having post-surgical symptoms. 2 The term postcholecystectomy syndrome (PCS) is referred to as the presence of signs and symptoms after an interventional cholecystectomy. 3 The definition is not explained elsewhere and sometimes mixed up with extra biliary disorders if they cause symptoms similar to postcholecystectomy.…”