| Abstrakt: |
Aim: To assess laparoscopic choledochoscopy and compare the results of two different routes of access for laparoscopic common bile duct exploration, namely the transcystic versus the transductal approach. Material-Method: One hundred and sixty-eight (168) patients were subjected to laparoscopic choledochoscopy for exploration of the common bile duct (CBD) for stones. The patients were categorized into three groups: group A included 34 patients subjected to transcystic choledochoscopy with a 2 mm choledochoscope; group B comprised 112 patients submitted to transductal choledochoscopy through choledochotomy with a 4.5mm choledochoscope; and group C included 32 patients whose preoperative ERCP sphincterotomy was unsuccessful for various reasons. In both transcystic and transductal access, we measured the rate of entrance of the choledochoscope into the cystic duct (CD) and into the CBD, the rate of stone clearance from the CBD, of the view of the CBD proximally or distally, of passing the choledochoscope into the duodenum, the length of hospital stay, conversion of the method, and the rate of complications in the three groups. Finally, we determined the sensitivity and precision of the choledochoscopy. Two different types of choledochoscopes were used: the 'Olympus CHF type CB 30L' for the transcystic method (2 mm) and the 'Olympus CHF type P20Q' for the transductal route (4.5 mm). Results: The rate of entrance of the choledochoscope through the cystic duct was 70.6% and through choledochotomy it reached 100%. CBD clearance was 91.66% in group A, 96.42% in group B and 96.87% in group C. The view of the distal CBD was 100% in both transcystic and transductal access, but the view of the proximal CBD was only 12.5% in the transcystic approach as opposed to 100% in the transductal approach (p<0.001). The rate of conversion of one procedure to another was 27.3%, 1.8% and 34.3% for groups A, B and C, respectively (p<0.001). The rate of passing the choledochoscope into the duodenum was 70.8% in group A and 31.2% in group B (p<0.025). Mean length of hospital stay was 2.25 days in group A, 5.15 days in group B and 12.4 days in group C (p<0.05). The complication rate was 4.16%. 6.25% and 18.75% in groups A, B and C, respectively. Finally, the sensitivity of choledochoscopy regarding the clearance of CBD was 100% for all groups and the precision was 91.66%, 96.42% and 96.87% in groups A, B and C, respectively. Conclusion: Regardless of the route chosen, laparoscopic choledochoscopy is an extremely reliable method with very high sensitivity and precision as concerns the clearance of CBD stones, provided that the criteria of patient selection are strictly observed. In addition, its reproducibility in both transcystic or transductal routes establishes laparoscopic choledochoscopy as the gold standard procedure for common bile duct exploration. [ABSTRACT FROM AUTHOR] |
Full text from SpringerLink