Laparoscopic choledochotomy in the management of choledocholithiasis. A report of 32 cases.

OBJECTIVE: we describe a choledochotomy technique for the laparoscopic removal of calculi in the management of choledocholithiasis, with an analysis of the results obtained in our first 32 patients. METHODS: a prospective study was made of all patients who underwent laparoscopic choledochotomy in our surgical service in the period between December 1993 and December 1996. A total of 112 patients diagnosed as having choledocholithiasis were operated on in our service in the course of the study. Of the 54 patients who initially underwent laparoscopic surgery, 32 underwent cholecystectomy, choledochotomy, extraction of stones and laparoscopic choledochorrhaphy. RESULTS: in 30 patients (93.75%) laparoscopic surgery could be completed without resorting to open surgery; in 5 of these patients primary choledochorrhaphy was performed, and in the remaining patients suturing was performed on a Kehr T-tube. Mean surgical time was 176 min. Two slight complications (one acute gastric dilatation and one small biliary fistula) and one severe complication (bowel fistula) were recorded. Mean hospital stay was 7 days. CONCLUSIONS: choledocholithiasis was successfully managed with laparoscopic choledochotomy and the extraction of stones, with no increase in morbidity or mortality in comparison to other therapeutic modalities.