Reoperation of biliary tract by laparoscopy.

BACKGROUND

Patients with previous operation of biliary tract were considered in the past as a contraindication to perform reoperation by laparoscopy. As experience with laparoscopic techniques and instrumentation has expanded, laparoscopic reoperation of biliary tract has become an accepted procedure in the management of cholelithiasis. Here we introduce our interesting experience with regard to reoperation of biliary tract by laparoscopy.

METHODS

Laparoscopic operation of biliary tract was performed on 3,674 consecutive patients from April 1992 to June 2005. Among these patients, 26 had a previous open operation of biliary tract whose clinical data were analyzed retrospectively : seven cases had complicated intrahepatic bile duct stones (restricted at hepatic duct of the first and the 2nd order); Diameter of common bile duct in patients with common duct stones was above 1.2 cm and the numbers of stones from each patient was more than 3 and the biggest stone exceeded 1 cm. All 26 patients were preoperatively excluded to present stenosis of bile duct and malignant tumor by both radiological examination and detection of serological tumor markers.

RESULTS

The mean operative time was 125 min (75-190 min). Reoperations of biliary tract by laparoscopy were successfully accomplished in 25 patients. One patient was converted to open operation whose common duct stones were taken out by right angle forceps through a short incision. None of the patients developed any severe complication and all of them recovered and were discharged. Three cases with retained calculus were successfully cured by taking them out through the sinus tract of T tube.

CONCLUSIONS

Laparoscopic procedure is minimally invasive, is safe and feasible for reoperation of the biliary tract. And it is a first choice method for cases to whom endoscopic sphincterotomy is contraindicated.