Laparoscopic Common Bile Duct Exploration for Stones at a Resource Poor Hospital in Trinidad & Tobago: A Retrospective Study

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Shamir O Cawich Fawwaz Z. Mohammed Vijay Narayansingh

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.

Keywords: Laparoscopic Common Bile Duct Exploration, Common Bile Duct Exploration for Stones, Retrospective Study, Trinidad & Tobago, Laparoscopic Common Bile Duct Exploration for Stones

Article Details

How to Cite
CAWICH, Shamir O; MOHAMMED, Fawwaz Z.; NARAYANSINGH, Vijay. Laparoscopic Common Bile Duct Exploration for Stones at a Resource Poor Hospital in Trinidad & Tobago: A Retrospective Study. Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4179>. Date accessed: 22 nov. 2024. doi: https://doi.org/10.18103/mra.v11i8.4179.
Section
Case Reports

References

1. Kullman E, Borch K, Lindstrom E, Svanvik J, Anderberg B. Management of Bile Duct Stones in the Era of Laparoscopic Cholecystectomy: Appraisal of Routine Operative Cholangiography and Endoscopic Treatment. Eur J Surg. 1996; 162(11): 873-80.

2. Martin H, Sturgess R, Mason N, Ceney A, Carter J, Barca L, Holland J, Swift S, Webster GJ. ERCP for bile duct stones across a national service, demonstrating a high requirement for repeat procedures. Endosc Int Open. 2023; 11(2): E142-E148.

3. McFarlane MEC, Thomas CAL, McCartney T, Bhoorasingh P, Smith G, Lodenquai P, Mitchell DIG. Selective operative cholangiography in the performance of laparoscopic cholecystectomy. Int J Clin Pract. 2005; 59(11):1301-3.
4. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004; 239(1): 28-33.

5. Rabago LR, Vicente C, Soler F, et al. Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 2006;38:779–86.

6. Plummer JM, Arthurs M, McDonald AH, Mitchell DIG, McFarlane MEC, Newnham M, West W. Endoscopic retrograde cholangiopancreatography use at the University Hospital of the West Indies. West Ind Med J. 2004; 53(4): 234-7.

7. Cawich SO, Arthurs M, Murphy T, Bonadie KO, Roberts HA, Naraynsingh V. Complications of ERCP for Choledocholithiasis in a Sickle Cell Cohort. Trop Doctor. 2015 Jan;45(1):15-20.

8. Gao YC, Chen JMM, Qin QM, Chen HM, Wang WM, Zhao JM, Miao FM, Shi XM. Efficacy and safety of laparoscopic bile duct exploration versus endoscopic sphincterotomy for concomitant gallstones and common bile duct stones: A meta-analysis of randomized controlled trials. Medicine. 2017; 96(3): e7925.

9. Darkahi B, Liljeholm H, Sandblom G. Laparoscopic common bile duct exploration: 9 years’ experience from a single center J Front Surg. 2016;3:1–5

10. Savita KS, Bhartia VK. Laparoscopic CBD Exploration. Indian J Surg. 2010; 72(5): 395-399.

11. Thompson MH, Tranter SE. All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg. 2002;89(12):1608–1612.

12. Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg. 2010;145:28–33.

13. ElGeidie AA, ElShobary MM, Naeem YM. Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones: a prospective randomized trial. Dig Surg. 2011;28:424–31.

14. Rendell VR, Pauli EM. Laparoscopic Common Bile Duct Exploration. JAMA Surgery. 2023; doi:10.1001/jamasurg.2022.8141

15. Guruswamy KS, Samraj K. Primary closure versus T-tube drainage after laparoscopic common bile duct exploration. Cochrane Database Syst Rev. 2007;1:CD005641.

16. Morcillo IA, Quarashi K, Carriona JA, Isla AM. Laparoscopic Common Bile Duct Exploration. Lessons Learned After 200 Cases. Cirugia Espanola. 2014; 92(5):341-347.

17. Cawich SO, George V, Padmore G, Griffith S, Greenidge C, Thomas D, Coye A, Rambaran N, Narayansingh V. Laparoscopic Common Bile Duct Exploration: Perceptions from the Caribbean College of Surgeons. J Caribbean Coll Surg. 2023; 2: In press

18. Pan L, Chen M, Ji L, et al. The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up To Date Meta-Analysis. Ann Surg. 2018, 268:247-253.

19. Lei, C., Lu, T., Yang, W. et al. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc. 35, 5918–5935 (2021).

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