Laparoscopic Choledocolithotomy in Post-Gastrectomy Patients

Eiji Sakamoto, Hiroshi Hasegawa, Shunichiro Komatsu, Yasuhiro Kurumiya, Shinji Norimizu, Tomotake Tabata, Seiji Natsume, Taro Aoba, Tomonori Tsuchiya and Naoki Matsumoto

Department of Surgery, Nagoya Daini Red Cross Hospital

Background: In post-gastrectomy patients endoscopic lithotomy is often difficult because of gastrointestinal reconstruction. Therefore the role of surgery is important in these cases. Methods: We have taken a laparoscopic approach in 19 cases of choledocholithiasis in patients with previous gastric surgery. Results: In 15, surgery was successful. Of the 19, 7 underwent distal gastrectomy with Billroth first reconstruction, 7 with Billroth second reconstruction, and five total gastrectomy with Roux-Y reconstruction. The conversion rate was 14%, 29%, and 20%. No significant difference was seen among groups. Eleven cases involved benign gastric disease and 8 malignant disease. The conversion rate was 27% and 13%, which also showed no significant difference. No significant relationship was seen between the conversion rate and the time interval from initial gastric surgery to most recent biliary surgery. ERC was conducted in 6 of the 19 cases. The rate of successful ERC was 57% in B-1 reconstruction, 29% in B-2, and 0% in R-Y. Five underwent transcystic lithotomy and 10 underwent choledocotomy. The postoperative hospital stay was 4.6 days in the trans-cystic case, and 12.7 days in the choledocotomy case. Conclusions: We believe that laparoscopic choledocolithotomy in post-gastrectomy patients is possible in many cases, and one of the therapeutic choises.

Key words
choledocholithiasis, laparoscopic surgery, post-gastrectomy

Reprint requests
Eiji Sakamoto Department of Surgery, Nagoya Daini Red Cross Hospital
2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650 JAPAN

Accepted
July 25, 2007

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