Urgent one stage laparoscopic intraoperative sonoscopy and choledochoscopy in patients with suspected choledocholythiasis

Introduction: Laparoscopic cholecystectomy is standardized procedure in the management of patients with acute cholecystitis, however definition of indications for laparoscopic common bile duct exploration in (LCBDE) is still a matter of debate. The aim of study was to share our experience in application of urgent one stage laparoscopic sonoscopy and choledochoscopy in patients with suspected choledocholithiasis. Method: 127 urgently admitted surgical patients with suspected choledocholithiasis (dilation of common bile duct on abdominal ultrasound, elevated bilirubin levels, biliary pancreatitis and cholangitis) were prospectively included in study during the time period from August 2012 till July 2013. All patients had indications for surgery and were chosen for one stage approach considering intraoperative ultrasound investigation of biliary tree followed by LCBDE in cases of choledocholithiasis. Further analysis of clinical data, overall complication rate and outcomes was done only if LCBDE was performed. Results: LCBDE was done in 53 patients. From all 37 patients were jaundiced, 32 had cholangitis, 13 biliary pancreatitis and 25 signs of cholecystitis. In 23 patients procedure was done in 72 hours (median 2 days) and in 30 > 72 hours (median 6 days) after admission. There was 29 transcystic and 24 transductal LCBDE with median IQR operative time of 80 (117-70) versus 127.5 (147-112) minutes, p < 0.001. T-tubes were placed only in 2 (8.3%) patients with transductal approach. Complete bile duct clearance was achieved in 92.5% leading to conversion rate of 7.5%. Readmission and ERCP for missed stones were needed in two patients. Overall postoperative complication rate reached 13.2% including bile leak, bleeding form liver bed and PATE. Median IQR hospital stay was 9 (15- 7) days. There was no mortality in our series. Conclusions: Intraoperative sonoscopy followed by LCBDE is feasible and safe procedure that can be provided in urgently admitted patients with choledocholythiasis.