3D Laparoscopic common bile duct exploration with primary repair by absorbable barbed suture is safe and feasible
Background and aim: Endoscopic retrograde cholangiopancreatography (ERCP), with interval laparoscopic cholecystectomy (LC), is the most common treatment approach for common bile duct (CBD) stones. However, recent studies show that single-stage laparoscopic CBD exploration (LCBDE) is safe and feasible. Three-dimensional (3D) laparoscopy enhances depth perception and facilitates intracorporeal suturing. The application of 3D technology for LCBDE is emerging, and we report our case series of 3D LCBDE.
Methods: We audited the twenty-seven consecutive 3D LCBDE performed from July 2017 to January 2020. We have a liberal policy for Magnetic resonance cholangiopancreatography (MRCP) in patients with deranged liver function tests (LFT). All CBD explorations were done through choledochotomy with a 5mm flexible choledochoscope and primarily repaired with an absorbable barbed suture without a stent or T-tube.
Results: The mean age of patients was 68 (range 44 - 91) years, and 12 (44%) were male. The indications for surgery were choledocholithiasis 67% (n=18), cholangitis 22% (n=6) and gallstone pancreatitis 11% (n=3). 67% (n=18) had pre-operative ERCP. 37% (n=10) had pre-operative biliary stent. Preoperative MRCP was done in 74% (n=20), and the mean diameter of CBD was 14.5 mm (range 7-30). The median operative time was 160 (range 80 -265) minutes. The operative drain was inserted in 18 patients. One patient each (4%) had a bile leak and a retained stone. There was no open conversion, readmission, or mortality.
Conclusion: 3D LCBDE with primary repair by an absorbable barbed suture is safe and feasible.
Relevance for patients: This paper emphasized that one stage LCBDE should be a treatment option which is comparable with 2 stage ERCP followed by LC to treat CBD stones. In addition, 3D technology and barbed sutures use in LCBDE is safe and useful.
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