Abstract
Background: Surgeons in the Caribbean are generally reluctant to perform laparoscopic common bile duct (CBD) exploration at the time of cholecystectomy because exploration is perceived to have low clearance rates. We routinely perform laparoscopic explorations for CBD stones at the Port of Spain General Hospital in Trinidad & Tobago. This retrospective study sought to document outcomes after laparoscopic CBD exploration.
Methods: We identified all patients who underwent laparoscopic CBD exploration for stone extraction at the General Hospital in Port of Spain over a ten-year period from January 1, 2013 to January 30, 2023. The following data were extracted: demographic details, operating time, stone clearance rates, retained stone rates, conversions, complications. All data were entered into an excel database and the data were analyzed with SPSS version 20.
Results: Intra-operative cholangiograms were performed in 49 patients, and CBD stones identified in 12 (25%) patients at a mean age of 48.7+/- 8.63 years. These patients underwent laparoscopic CBD exploration without prior endoscopic retrograde cholangio-pancreatography. The mean stone burden was 4.7+/-2.54 stones. Four (33%) patients had attempts at trans-cystic exploration, and they all required choledochotomies to complete CBD exploration. Eight patients had initial attempts at choledochotomy for stone extraction. The mean operating time for laparoscopic cholecystectomy, operative cholangiography and CBD exploration with duct clearance was 169.6+/-35.1 minutes. There were 2 (17%) conversions, 1 (8.3%) complication (bile leak) and no mortality. Stone clearance rate was 91.7% (11). The mean duration of hospitalization was 0.6 days. There were no instances of retained or recurrent CBD stones in this series.
Conclusions: While laparoscopic CBD exploration does demand increased skill sets, such as laparoscopic suturing, mastering duct exploration techniques, interpreting biliary anatomy and operative cholangiography, we have shown that it is feasible in the resource poor Caribbean setting. Surgeons planning to perform laparoscopic CBD exploration should have a working knowledge of biliary anatomy and variations and the ability to suture laparoscopically.