[Advantages of laparoscopic stented choledochorrhaphy. Six years experience]. / Ventajas de la coledocorrafia laparoscópica sobre el stent. Experiencia tras seis años.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is nowadays a valid option in the management of common bile duct stones. T tube and primary closure have been used to close the choledochotomy, but these methods are not free of complications. We present our experience with the stented choledochorrhaphy. MATERIAL AND METHOD: We retrospectively reviewed the data of 104 patients, who underwent LCBDE between January 1999 and February 2007. T tube was used in the first period. From July 2001 the method of choice has been the closure of the CBD over an endoprosthesis placed under direct view and later removed by gastroscopy. RESULTS: The technique was performed on 70 consecutive patients. Median operation time was 90 minutes. There was no conversion to open surgery. Stones could not be retrieved in 4.2% of patients. The median hospital stay was 4 days. Morbidity was 7%, although only 2.8% was related to the stent (acute pancreatitis). Postoperative mortality was 1.4%. CONCLUSIONS: The stented laparoscopic choledochorrhaphy allows an efficient biliary decompression, and seems to avoid the complications of the T tube and primary closure. This method should be considered as a valid option after choledochotomy.

Ventajas de la coledocorrafia laparoscópica sobre el stent. Experiencia tras seis años / Advantages of laparoscopic stented choledochorrhaphy. Six years experience

Introducción. La exploración laparoscópica de la vía biliar principal (ELVBP) es actualmente una alternativa válida en el tratamiento de la coledocolitiasis. Cuando se realiza a través de una coledocotomía, tradicionalmente se ha empleado la colocación de un tubo en T o el cierre primario, pero estos métodos no están exentos de complicaciones. Presentamos nuestra experiencia con un método alternativo mediante el cierre del colédoco sobre una endoprótesis. Material y método. Revisamos retrospectivamente los resultados recogidos de forma prospectiva de 104 pacientes con coledocolitiasis a los que se realizó ELVBP entre enero de 1999 y febrero de 2007. En un primer período se empleó el tubo en T. Desde julio de 2001 el método empleado ha sido el cierre de la vía biliar principal (VBP) sobre una endoprótesis biliar colocada bajo visión directa durante la intervención y retirada, posteriormente, de forma ambulatoria mediante una gastroscopia. Resultados. La técnica descrita se empleó en 70 pacientes consecutivos. La mediana del tiempo operatorio fue de 90 min. No hubo conversión a cirugía abierta. En un 4,2% de los pacientes no se pudo desimpactar los cálculos. La morbilidad fue del 7%, aunque sólo en un 2,8% fue relacionada con el stent (pancreatitis aguda). Un paciente falleció en el postoperatorio. La estancia hospitalaria mediana fue de 4 días. Conclusiones. La utilización de la endoprótesis biliar en el cierre laparoscópico de la VBP proporciona una descompresión eficaz, y aparentemente evita las complicaciones del tubo en T y del cierre primario. Por tanto, debe considerarse como una alternativa válida tras la coledocotomía laparoscópica (AU)

Background. Laparoscopic common bile duct exploration (LCBDE) is nowadays a valid option in the management of common bile duct stones. T tube and primary closure have been used to close the choledochotomy, but these methods are not free of complications. We present our experience with the stented choledochorrhaphy. Material and method. We retrospectively reviewed the data of 104 patients, who underwent LCBDE between January 1999 and February 2007. T tube was used in the first period. From July 2001 the method of choice has been the closure of the CBD over an endoprosthesis placed under direct view and later removed by gastroscopy. Results. The technique was performed on 70 consecutive patients. Median operation time was 90 minutes. There was no conversion to open surgery. Stones could not be retrieved in 4.2% of patients. The median hospital stay was 4 days. Morbidity was 7%, although only 2.8% was related to the stent (acute pancreatitis). Postoperative mortality was 1.4%. Conclusions. The stented laparoscopic choledochorrhaphy allows an efficient biliary decompression, and seems to avoid the complications of the T tube and primary closure. This method should be considered as a valid option after choledochotomy (AU)

The development of laparoscopic surgery in Spain.

AIM: To assess degree of development and level of acceptance of laparoscopic surgery in Spain. METHOD: A questionnaire was sent to all members of the Spanish Association of Surgeons in April 2003. It included 32 questions, 9 of which were general, and 23 referred to specific clinical situations, techniques, and standard practice. RESULTS: Eight hundred and fifty-eight (33.1%) surgeons replied. Only 211 (25%) surgeons reported performing advanced laparoscopic procedures. Four hundred and twenty (49%) surgeons believed that the results obtained with laparoscopic surgery were better than those obtained with conventional surgery, and 325 (40%) surgeons believed that laparoscopy would become a superspecialty. Laparoscopic surgery was considered the method of choice in the treatment of gallbladder stones (99%), gastroesophageal reflux disease (94%), acute cholecystitis (81%), in selected cases of inguinal hernia repair, and in procedures to be performed in spleen and adrenals, benign colon disease, and obesity. Three hundred and ninety-eight (47%) surgeons considered laparoscopic surgery the preferred approach for colon cancer, 292 (34%) for appendicitis, and 155 (18%) for incisional hernia. Five hundred and five (59%) surgeons considered that the use of laparoscopic surgery had grown less than expected. CONCLUSIONS: The vast majority of surgeons advocated laparoscopic surgery for the treatment of gallbladder stones and gastroesophageal reflux disease. Although most hospitals had the appropriate technical facilities for performing advanced laparoscopic procedures, few surgeons actually did so.