Application of laparoscopic cholecystectomy combined with common bile duct exploration through small incision in treatment of gallstone with common bile duct stones

Objective To investigate the application of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (CBDE) through a small incision in the treatment of gallstone with common bile duct stones.Methods A total of 23 cases of gallstone with common bile duct stones underwent laparoscopic cholecystectomy;the anterior wall of common bile duct was exposed under the laparoscope, and a 3-5 cm incision was made in the abdominal wall accordingly;the common bile duct was cut through the small incision, and stones were removed from the common bile duct with stone forceps;the fiber choledochoscope and rigid ureteroscope were used for common bile duct exploration and further stone removal if needed.Results Incision extension was not needed in any case.The time of operation was 90-160 min (mean, 120±10 min) ;the hospital stay was 10-20 d (mean, 13 d) .Twenty-one cases were cured and discharged after the T-tube was pulled out.Two cases had residual stones in the right hepatic duct after operation, as detected by T-tube cholangiography and B-mode ultrasound, and were discharged with the T-tube in place;the 2 cases had the residual stones removed by the choledochoscope at 6 weeks after operation and were cured.Two cases had pulmonary infection, and both had grade A healing.Conclusion LC combined with CBDE through a small incision is minimally invasive;it is safer than the laparoscope-free procedure through a small incision, and it is more efficient and has better stone removal effect compared with total laparoscopic surgery.This surgical approach is suitable for use in primary hospitals.