Therapeutic laparoscopy combined with choledochoscopy or duodenoscopy in detail choledochus stones

Objective To evaluate combination of choledochoscopy or duodenoscopy with therapeutic laparoscopy （LCDCS） in treatment of detail choledochus stones. Methods Laparoscopic cholecystectomy was firstly performed and followed by choledochoscopy or duodenoscopy . Procedures of therapeutic choledochoseopy were as follows： choledochoscopic exploration via cystic duct remnant, choledochotomy, electrohydralic lithothipsy, drainage of bile duct with ureteral catheter via cystic duct remnant, T-tube drainage, or the suture of duct incision. Procedures of therapeutic duodenoscopy were as follows： access to the common bile duet and duodenum through ureteric catheter and zebra guidewire via cholecystic duet remnant, duodenoscopy via oral cavity into the duodenum papilla, papillotomy with needle-knife or arch-like electro-knife along the urcteric catheter or zebra guidewire, and stone clearance in the common bile duct with the reticulation and balloon of duodenoscopy. Results Combination therapy were given to 191 cholelithiasis patients with detail choledochus stones. Combined choledochoscopy were performed in 117 patients. Stones were completely removed and average operation time was 114 min. Bile leakage occurred in 7 cases, but was cured with drainage. Postoperative imaging showed 2 cases of bile duet stenosis at primary closure of duct incision. Combined duodenoscopie procedures were performed in 74 patients. Papillotomy and stone clearance were successfully performed in 68 patients, 5 others of whom underwent successful papillotomy only, and another underwent other operations. Average operation time was 97 min. Post-operation mild acut pancreatitis developed in 6 patients. No perforation of intestine or bile duct, bleeding, severe pancreatitis, or death was observed in each group. Conclusion LCDCS was safe and effective with appropriate indications. Key words: Laparoscopy ;  Cholelithiasis ;  Therapy ;  Choledochoscopy;  Duodenoscopy