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Long-term Outcome

Dan I. Giurgiu, MD; Daniel R. Margulies, MD; Brendan J. Carroll, MD; Joubin Gabbay, BA; Atsushi Iida, MD; Sumito Takagi, MD; Moses J. Fallas, MD; Edward H. Phillips, MD

Arch Surg. 1999;134:839-844.

Hypothesis  Transcystic laparoscopic common bile duct exploration (LCBDE) with biliary endoscopy results in excellent long-term clinical outcome and patient satisfaction.

Design  Prospective cohort study of unselected patients found to have common bile duct stones during laparoscopic cholecystectomy between October 1989 and April 1998. A mailed survey assessed symptoms, outcome, and satisfaction.

Setting  A large community teaching hospital.

Patients  Two hundred seventeen patients with common bile duct stones.

Intervention  Transcystic LCBDE with choledochoscopy.

Main Outcome Measures  Success of LCBDE, morbidity, postoperative symptoms, and satisfaction.

Results  One hundred sixteen surveys (54%) were returned. Mean follow-up was 60 months. The LCBDE procedure failed in 6 patients and endoscopic retrograde cholangiopancreatography was performed in 4 patients (3%). One patient had unsuspected retained stones. No patient had late recognition of retained stones or a bile duct stricture. Abdominal pain was present in 90 patients (89%) preoperatively and in 29 patients (26%) postoperatively (P=.001). The LCBDE procedure reduced 3 specific pain profiles: epigastric, from 47% (n=54) to 7% (n=8); back, from 31% (n=36) to 6% (n=7); and shoulder, from 18% (n=21) to 2% (n=2). When pain persisted, it was different in character in 15%. All nonpain symptoms (such as nausea, bloating, indigestion, and gas) were reduced from 78% (n=91) to 34% (n=39) (P=.001) except diarrhea. Diarrhea was present in 24 patients (22%) preoperatively and postoperatively, though it was a new postoperative symptom in 11 patients (11%). One hundred two patients (95%) were satisfied or mostly satisfied with LCBDE.

Conclusions  Pain and nonpain symptoms, while reduced significantly after LCBDE, may persist. The LCBDE procedure does not result in common bile duct strictures or a significant rate of retained stones. This relatively new treatment for common bile duct stones is safe and effective.

From the Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.