Laparoscopic Management of Cholecysto- or Choledocho-Lithiasis and its Complications

Tatsuo Yamakawa

Department of Surgery, Teikyo University Hospital at Mizonokuchi

Although the advantages of laparoscopic cholecystectomy over open cholecystectomy in terms of less postoperative pain, shorter hospitalization and earlier resumption of activity, in addition to better cosmetics, are apparent, it has been documented that complications such as bile duct injury occur more frequently during laparoscopic surgery than open surgery. Moreover, the risk of intraoperative injury to bowel or major blood vessels which are unique to laparoscopic surgery have been reported. On the other hand, the management of choledocholithiasis by laparoscopy has been also attemted in many institutions and favorable results have been reported in the literatures. An additional concerns arised here is the risk of retained stones. In this paper, fundamental techniques to prevent these complications and make laparoscopic surgery a standard procedure for the management of cholecysto- and choledocholithiasis are detailed and the need to place a T-tube for the management of possible retained stones is also advocated based on the limitations of EST and laparoscopic intraoperative examinations. Moreover, it is emphasized that surgeons who attempt to do laparoscopic surgery must be; 1. competent for the special techniques required by laparoscopic surgery,2. competent for the techniques of general surgery, and 3. competent for the management of difficulties frequently encountered during surgery and predictive postoperative complications.

Key words
laparoscopic cholecystectomy, cholecystolithiasis, choledocholithiasis, complications of laparoscopic surgery

Reprint requests
Tatsuo Yamakawa Department of Surgery, Teikyo University Hospital at Mizonokuchi
74 Mizonokuchi, Takatsu-ku, Kawasaki, 213 JAPAN

Accepted
May 11, 1993

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