This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Laparoscopic common bile duct exploration. BJS 2014; 101: 1448-1452.

Published: 14th August 2014

Authors: D. S. Y. Chan, P. A. Jain, A. Khalifa, R. Hughes, A. L. Baker

Background

Laparoscopic common bile duct exploration (LCBDE) is a safe and effective single‐stage treatment for choledocholithiasis in the elective setting. The outcomes after LCBDE in the emergency setting are unknown. The aim of this study was to compare the outcomes following elective and emergency LCBDE for choledocholithiasis.

Method

Details of all patients who underwent LCBDE for choledocholithiasis between August 2003 and August 2013 were analysed retrospectively. The primary outcome measure was common bile duct (CBD) stone clearance rate. Secondary outcome measures were conversion rate, morbidity, mortality and length of hospital stay.

Results

Some 215 consecutive patients (57 male; median age 65 (range 14–92) years) underwent LCBDE. Some 121 procedures were performed electively and 94 as an emergency. Forty‐five patients (48 per cent) presented with obstructive jaundice or cholangitis in the emergency LCBDE group compared with 15 (12·4 per cent) in the elective group (P < 0·001). The CBD stone clearance rate was similarly high in both groups (96 versus 96·7 per cent respectively; P = 0·557). There were no significant differences in conversion rate (6 versus 4·1 per cent), morbidity (5 versus 6·6 per cent), mortality (2 versus 0 per cent) or median length of stay (3 days) between groups. Two patients died, both following emergency LCBDE.

Conclusion

LCBDE can be performed safely and effectively in both elective and emergency settings.

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