Treatment of Common Bile Duct Stones in Era of Minimaly Invasive Surgery in General Hospital Setings

Although laparoscopic cholecystectomy has become the golden standard in the treatment of the gallstone disease, the treatment of common bile duct stones (CBDS) continues to raise numerous discussions. The frequency of gallstones runs about 12% among the male and about 24% among the female population with 10-30% of the patients developing the symptoms of the disease. In 10-15% of the patients that underwent cholecystectomy, common bile duct stones were found either during the preoperative, intraoperative or postoperative evaluation. The treatment of common bile duct stones at the department of surgery in our hospital includes open exploration,laparoscopic exploration (LCBDE ) and ERCP and ES (preoperative and postoperative). During the period between 2007 and 2009 we have performed 47 open explorations, 9 laparoscopic transcystic exploration, as well as 112 ERCP and ES. The success rate of the cases of open exploration was 95%, in 2 cases postoperative cholangiogram showed concrement residues that were successfully treated later on with ERCP+ES. Out of 9 transcystic LCBDE we have performed (we don't perform laparoscopic choledochotomy), in 4 cases extraction was succesfull, 3 patients underwent conversion into open exploration, and 2 patients were successfully treated with postoperative ERCP. Altogether, we have performed 112 ERCP procedures, of which 43 were diagnostic. A total of 69 patients were treated with ERCP, and ES (preoperatively and postoperatively) with the 82% success rate of stone extraction (57 successful extractions). In cases where ERCP and ES failed we opted for open exploration. When it comes to ERCP and ES, we achieved greatest success with cases of CBDS after cholecystectomy (42).