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Suwatthanarak T, Chinswangwatanakul V, Methasate A, Phalanusitthepha C, Tanabe M, Akita K, Akaraviputh T. Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence. World J Gastrointest Endosc 2024; 16:305-317. [DOI: 10.4253/wjge.v16.i6.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
While endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment modality for common bile duct stones (CBDS) or choledocholithiasis due to advancements in instruments, surgical intervention, known as common bile duct exploration (CBDE), is still necessary in cases of difficult CBDS, failed endoscopic treatment, or altered anatomy. Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes. This review elucidates relevant clinical anatomy, selection indications, and outcomes to enhance surgical understanding. The selection between trans-cystic (TC) vs trans-choledochal (TD) approaches is described, along with stone removal techniques and ductal closure. Detailed surgical techniques and strategies for both the TC and TD approaches, including instrument selection, is also provided. Additionally, this review comprehensively addresses operation-specific complications such as bile leakage, stricture, and entrapment, and focuses on preventive measures and treatment strategies. This review aims to optimize the management of CBDS through laparoscopic CBDE, with the goal of improving patient outcomes and minimizing risks.
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Affiliation(s)
- Tharathorn Suwatthanarak
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Vitoon Chinswangwatanakul
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Asada Methasate
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Chainarong Phalanusitthepha
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Thawatchai Akaraviputh
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
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Tzeng WJ, Lin YH, Hou TY, Yin SM, Lin YC, Liu YW, Liu YY, Li WF, Wang CC, Marescaux J, Diana M. Near-infrared cholangiography can increase the chance of success in laparoscopic approaches to common bile duct stones, even with previous abdominal surgery. BMC Surg 2023; 23:203. [PMID: 37454060 DOI: 10.1186/s12893-023-02103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The treatment of common bile duct (CBD) stones with minimally invasive surgery (MIS) is more technical demanding than laparoscopic cholecystectomy (LC), especially in patients with history of previous abdominal surgery, cholangitis or cholecystitis. Near-infrared (NIR) cholangiography via systemic or biliary tree administration of indocyanine green (ICG), which enhances the visualization of the biliary tree anatomy, may increase the reassurance of CBD localization. The aim of this study was to identify the benefit of near-infrared cholangiography for laparoscopic common bile duct exploration (LCBDE). METHODS Three groups of CBD stone patients were included in this retrospective study depending on the surgical methods: 1) open choledocholithotomy (OCC), 2) laparoscopic choledocholithotomy (LCC), and 3) near-infrared cholangiography-assisted laparoscopic choledocholithotomy (NIR-CC). For the NIR-CC group, either 3 ml (concentration: 2.5 mg/mL) of ICG were intravenously administered or 10 ml (concentration: 0.125 mg/mL) of ICG were injected directly into the biliary tree. The enhancement rate of the cystic duct (CD), CBD, the upper and lower margin of the CBD were compared using white light image. RESULTS A total of 187 patients with a mean age of 68.3 years were included (OCC, n = 56; LCC, n = 110; NIR-CC, n = 21). The rate of previous abdominal surgery was significantly lower in the LCC group. The conversion rate was similar between the LCC and the NIR CC groups (p = 0.746). The postoperative hospital stay was significantly longer in the OCC group. No differences in morbidity and mortality were found between the three groups. In the NIR-CC group, the localization of CBD was as high as 85% compared to 24% with white light imaging. CONCLUSIONS Near-infrared cholangiography helps increase the chance of success in minimally invasive approaches to CBD stones even in patients with previous abdominal surgeries, without increasing the rate of conversion.
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Affiliation(s)
- Wei-Juo Tzeng
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Hung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Teng-Yuan Hou
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Shih-Min Yin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Cheng Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yueh-Wei Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Yu-Yin Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan.
| | - Wei-Feng Li
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Chih-Chi Wang
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Jacques Marescaux
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- ICube Lab, Photonics for Health, University of Strasbourg, Strasbourg, France
- Department of Surgery, University Hospital of Strasbourg, Strasbourg, France
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Chiu BY, Chuang SH, Chuang SC, Kuo KK. Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review. World J Clin Cases 2023; 11:1939-1950. [PMID: 36998949 PMCID: PMC10044958 DOI: 10.12998/wjcc.v11.i9.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.
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Affiliation(s)
- Bo-Ya Chiu
- School of Post-baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Mansour S, Kluger Y, Khuri S. Primary Recurrent Common Bile Duct Stones: Timing of Surgical Intervention. J Clin Med Res 2022; 14:441-447. [PMID: 36578366 PMCID: PMC9765319 DOI: 10.14740/jocmr4826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Cholelithiasis (gallstones) is a very common medical problem worldwide, with 5-30% of patients demonstrating a combined condition of cholelithiasis and choledocholithiasis (common bile duct stones (CBDS)). CBDS are usually classified as primary or secondary stones. Primary CBDS are defined as stones detected 2 years or more following cholecystectomy, while secondary stones, the most common type, usually migrate from the gallbladder to the bile ducts. Recurrent CBDS are defined as stones detected 6 months or more following endoscopic retrograde cholangiopancreatography (ERCP) with complete duct clearance. Although ERCP with endoscopic sphincterotomy has emerged as the main therapeutic option for CBDS, with up to 95% bile duct clearance rate, up to 25% of said patients develop recurrent bile duct stones. Thus far, several issues related to recurrent CBDS are still unclear and questions regarding this specific pathology have no precise answers: how many trials of ERCP and endoscopic sphincterotomy should be attempted before referring the patient for surgical management? Is there an association between risk factors and early surgical intervention? Thus, currently, there is no worldwide scientific-based consensus regarding the best management of this specific group of patients. The main issue for this article is to review the relevant English literature and find out the main high risk factors for recurrent CBDS, and form a diagnostic and treatment plan, hence, identifying the subgroup of patients that will benefit from early surgical management, preventing further ERCP-associated complications.
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Affiliation(s)
- Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel,Corresponding Author: Safi Khuri, Department of General Surgery, Rambam Health Care Campus, Haa’leya Hashniya, Haifa 31096, Israel.
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Comparison of one-stage laparoscopic common bile duct exploration plus cholecystectomy and two-stage endoscopic sphincterotomy plus laparoscopic cholecystectomy for concomitant gallbladder and common bile duct stones in patients over 80 years old. JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:11-17. [PMID: 35603338 PMCID: PMC8977497 DOI: 10.7602/jmis.2022.25.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022]
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Lee SJ, Choi IS, Moon JI, Choi YW. Optimal treatment for concomitant gallbladder stones with common bile duct stones and predictors for recurrence of common bile duct stones. Surg Endosc 2021; 36:4748-4756. [PMID: 34734299 DOI: 10.1007/s00464-021-08815-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal treatment for concomitant gallbladder (GB) stones with common bile duct (CBD) stones and predictors for recurrence of CBD stones are not established. METHODS This single-center, retrospective study reviewed 466 patients diagnosed with a first event of concomitant GB stones with CBD stones from January 2010 to December 2018. RESULTS 92 patients underwent single-stage laparoscopic CBD exploration (LCBDE) and laparoscopic cholecystectomy (LC) (group1), 108 underwent LCBDE + LC after endoscopic stone extraction (ESE) failure (group2), and 266 underwent ESE + LC (group3). Clearance (95.7 vs. 99.1 vs. 97.0%, p = 0.324) and recurrence rates (5.4 vs. 13.0 vs. 7.9%, p = 0.138) did not differ between groups. Group1 had fewer procedures (p < 0.001), lower post-treatment complication rates (7.6 vs. 18.5 vs. 13.9%, p = 0.082), and shorter hospital stay after the first procedure (5.7 vs 13.0 vs 9.8 days, p < 0.001). 40 patients (8.6%) had recurrence of CBD stones at mean follow-up of 17.1 months, of which 29 (72.5%) occurred within 24 months. In multivariate analysis, a CBD diameter > 8 mm, combined type-1 periampullary diverticulum, and age > 70 years were significant predictors of recurrence. CONCLUSION Single-stage LCBDE + LC is a safe and effective treatment for concomitant GB stones with CBD stones compared to ESE + LC. LCBDE should be considered in patients with a high risk of ESE failure. Careful follow-up is recommended for patients at high risk of recurrence of CBD stones, especially within 24 months after surgical or endoscopic treatment.
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Affiliation(s)
- Seung Jae Lee
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - In Seok Choi
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea.
| | - Ju Ik Moon
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - Yong Woo Choi
- Department of Internal Medicine, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Zhu J, Zhang Y, Du P, Hu W, Xiao W, Li Y. Systematic Review and Meta-analysis of Laparoscopic Common Bile Duct Exploration in Patients With Previous Failed Endoscopic Retrograde Cholangiopancreatography. Surg Laparosc Endosc Percutan Tech 2021; 31:654-662. [PMID: 33973942 DOI: 10.1097/sle.0000000000000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim was to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (group A) versus primary LCBDE (group B) for the management of gallbladder and common bile duct stones. MATERIALS AND METHODS A comprehensive and systematic literature search was performed in several databases, including PubMed, Ovid, and Cochrane Library. Meta-analysis of operative outcomes, postoperative outcomes, and gallstone clearance rates was conducted using random-effect models. RESULTS Six studies including 642 patients (239 in group A and 403 in group B) were included. The operative time was longer in group A (P=0.02). The overall complication, bile leakage, conversion, postoperative hospital stay, and reoperation were comparable in group A and group B. Similarly, no significant difference was present concerning the incidence of stone clearance, residual stone, and recurrent stone (P>0.05). CONCLUSION LCBDE is an alternative acceptable procedure when removal of common bile duct stones by endoscopic therapy fails.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Quality of Life Outcomes Following Single-stage Laparoscopic Common Bile Duct Exploration Versus 2-stage Endoscopic Sphincterotomy Followed by Laparoscopic Cholecystectomy in Management of Cholelithiasis With Choledocholithiasis. Surg Laparosc Endosc Percutan Tech 2021; 31:285-290. [PMID: 33538548 DOI: 10.1097/sle.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION With various studies in the literature showing laparoscopic common bile duct (CBD) exploration to have equal or similar results when compared with endoscopic sphincterotomy (EST) clearance, decision-making in regard to the treatment modality to be used may become debatable. Thus, quality of life (QoL) data may assist both the patient and the clinician in deciding the management of the disease. The present prospective randomized trial was undertaken to compare QoL of patients undergoing treatment with these 2 approaches. METHODOLOGY The study was conducted March 1, 2013, to September 31, 2016. Consecutive patients with CBD stones were randomized to either laparoscopic CBD exploration with cholecystectomy (group I) and EST followed by laparoscopic cholecystectomy (group II). Diagnosis was confirmed preoperatively using magnetic resonance cholangiopancreatography and/or endoscopic ultrasound. QoL scores were assessed by World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), and Hospital Anxiety and Depression Scale (HADS) questionnaires. RESULTS A total of 77 patients with concomitant gallstones and CBD stones were finally recruited (38 patients in group I and 39 patients in group II). The demographic and clinical profiles were similar in both the groups. On EORTC QLQ-C30 questionnaire, there was significant improvement in physical, emotional, and role functioning in both the groups (P<0.01) with no intergroup variation preprocedure or postprocedure. Patients in both the groups reported similar WHOQOL scores with significant improvement postprocedure and minimal intergroup variation. Both the depression and anxiety scores on HADS were comparable between the 2 groups preoperatively and at 3 months postoperatively. CONCLUSION Single-stage management of patients with gallbladder and CBD stones and EST followed by laparoscopic cholecystectomy were similar in terms of improvement in QoL.
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Vargas Avila AL, de Alba Cruz I, Vargas Flores J, Nagore Ancona JF, Cortazar Sánchez CA, Luis Sánchez D, Domínguez Rodríguez JA, Molina Tabárez KB. Treatment of choledocolithiasis by laparoscopic exploration of the bile tract after failed endoscopic retrograde cholangiopancreatography. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Brañes A, Pérez G. Laparoendoscopic rendezvous procedure in a patient with situs inversus totalis: A case report and review of the literature. Clin Case Rep 2020; 8:2595-2599. [PMID: 33363786 PMCID: PMC7752348 DOI: 10.1002/ccr3.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
Situs inversus totalis patients may be associated with difficulties in the diagnosis and treatment of surgical diseases. This case suggests that laparoendoscopic rendezvous procedure could be associated with a lower morbidity and length of hospital stay.
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Affiliation(s)
- Alejandro Brañes
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
| | - Gustavo Pérez
- Digestive Surgery DepartmentSchool of MedicinePontificia Universidad Católica de ChileSantiagoChile
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Surgical Techniques for the Laparoscopic Treatment of Bile Duct Stones in Patients With a History of Upper Abdominal Operations: Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2020; 29:503-508. [PMID: 31800398 DOI: 10.1097/sle.0000000000000678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Few authors have studied applying the laparoscopic approach in patients with previous upper abdominal operations, but no comparison has been made between laparoscopic and open approaches in patients with previous upper abdominal operations. This article aims to introduce surgical techniques and details in treatment to surgeons specialized in minimally invasive surgery. MATERIALS AND METHODS From January 2010 to January 2018, 460 eligible patients were divided into 3 groups and analyzed retrospectively. Group A: patients with a history of upper abdominal operations who underwent laparoscopy (n=124); group B: patients without a history of upper abdominal operations who underwent laparoscopy (n=140); and group C: patients with a history of upper abdominal operations who underwent an open operation (n=196). Group A was the experimental group; groups B and C served as the control groups. RESULTS No significant difference was found between groups A and B. Significant differences were found between groups A and C in estimated blood loss (258.3±67.2 vs. 424.7±103.7 mL, P<0.001), postoperative hospitalization (5.7±2.3 vs. 10.2±3.1 d, P<0.001), and postoperative complications (16.1% vs. 42.9%, P=0.013). The final rate of stones clearance was 100% in 3 groups. The total rate of stone recurrence was 7.8%. CONCLUSIONS Laparoscopy with certain surgical techniques was feasible, effective, and advantageous for patients with previous upper abdominal operations by experienced surgeons. It is necessary for surgeons to have advanced skills and surgical techniques to achieve a successful laparoscopy.
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Li ZQ, Sun JX, Li B, Dai XQ, Yu AX, Li ZF. Meta-analysis of single-stage versus two-staged management for concomitant gallstones and common bile duct stones. J Minim Access Surg 2020; 16:206-214. [PMID: 30618417 PMCID: PMC7440024 DOI: 10.4103/jmas.jmas_146_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: The purpose of this article was to compare the effectiveness and safety of single-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration [LCBDE]) with two-stage (LC plus endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy [EST]) in management for concomitant gallstones and common bile duct (CBD) stones. Materials and Methods: Systematic review and meta-analysis of randomised controlled trials (RCTs) comparing outcomes following single-stage with two-stage management for concomitant gallstones and CBD stones published from 1990 to 2017 in PubMed, Embase and the Science Citation Index. The primary outcomes were stone clearance from the CBD, post-operative morbidity and mortality. The secondary outcomes were retained stone, conversion to other procedures, length of hospital stay and total operating time. Pooled risk ratio (RR) or weighted mean differences (WMD) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. Results: Eleven RCTs studies were included in this analysis. These studies included a total of 1338 patients: 666 underwent LC + LCBDE and 672 underwent LC + ERCP/EST. The meta-analysis showed that no significant difference was noted between the two groups regarding CBD stone clearance (RR: 1.06; 95% CI: 0.99–1.14; P = 0.12), post-operative morbidity (RR: 1.03; 95% CI: 0.79–1.34; P = 0.81), mortality (RR: 0.30; 95% CI: 0.06–1.41; P = 0.13), retained stone (RR: 0.91; 95% CI: 0.57–1.47; P = 0.71), conversion to other procedures (RR: 0.80; 95% CI: 0.55–0.16; P = 0.23), length of hospital stay (WMD: 1.24, 95% CI: 3.57–1.09, P = 0.30), total operating time (WMD: 25.42, 95% CI: 22.38–73.22, P = 0.30). Conclusion: Single-stage is efficient and safe in the treatment of patients with concomitant gallstones and CBD stones while avoiding the second procedure. In selected patients, single-stage management for concomitant gallstones and CBD stones might be considered as the preferred approach. However, the findings have to be carefully interpreted due to the existence of heterogeneity, in addition, patient's condition, operator's experience also should be taken into account in making treatment decisions.
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Affiliation(s)
- Zhi-Qing Li
- Department of Hepatobiliary Surgery, Pingdu City People's Hospital, Weifang Medical College, Qingdao City, Shandong Province, China
| | - Ji-Xia Sun
- Qingdao Central Hospital, Qingdao City, Shandong Province, China
| | - Bin Li
- Department of Hepatobiliary Surgery, Pingdu City People's Hospital, Weifang Medical College, Qingdao City, Shandong Province, China
| | - Xue-Qiang Dai
- Department of Hepatobiliary Surgery, Pingdu City People's Hospital, Weifang Medical College, Qingdao City, Shandong Province, China
| | - An-Xing Yu
- Department of Hepatobiliary Surgery, Pingdu City People's Hospital, Weifang Medical College, Qingdao City, Shandong Province, China
| | - Zhe-Fu Li
- Department of Hepatobiliary Surgery, Pingdu City People's Hospital, Weifang Medical College, Qingdao City, Shandong Province, China
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Di Mauro D, Ricciardi E, Siragusa L, Manzelli A. Outcome of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography: A Comparative Study. J Laparoendosc Adv Surg Tech A 2019; 29:1391-1396. [DOI: 10.1089/lap.2019.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Davide Di Mauro
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Edoardo Ricciardi
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Manzelli
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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Gad EH, Zakaria H, Kamel Y, Alsebaey A, Zakareya T, Abbasy M, Mohamed A, Nada A, Abdelsamee MA, Housseni M. Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study. Ann Med Surg (Lond) 2019. [DOI: https:/doi.org/10.1016/j.amsu.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Gad EH, Zakaria H, Kamel Y, Alsebaey A, Zakareya T, Abbasy M, Mohamed A, Nada A, Abdelsamee MA, Housseni M. Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study. Ann Med Surg (Lond) 2019. [DOI: https://doi.org/10.1016/j.amsu.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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16
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Gad EH, Zakaria H, Kamel Y, Alsebaey A, Zakareya T, Abbasy M, Mohamed A, Nada A, Abdelsamee MA, Housseni M. Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study. Ann Med Surg (Lond) 2019; 43:52-63. [PMID: 31198552 PMCID: PMC6556483 DOI: 10.1016/j.amsu.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives For complicated common bile duct stones (CBDS) that cannot be extracted by endoscopic retrograde cholangiopancreatography (ERCP), management can be safely by open or laparoscopic CBD exploration (CBDE). The study aimed to assess these surgical procedures after endoscopic failure. Methods We analyzed 85 patients underwent surgical management of difficult CBDS after ERCP failure, in the period from 2013 to 2018. Results Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively. An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBDE(LCBDE), open CBDE(OCBDE) and the converted cases were 24.7% (n = 21), 70.6% (n = 60), and 4.7% (n = 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively, Eleven (12.9%) of our patients had postoperative complications without mortality. By comparing LCBDE and OCBDE; there was a significant association between the former and longer operative time. On comparing, T-tube and 1ry CBD closure in both OCBDE and LCBDE, there was significantly longer operative time, and post-operative hospital stays in the former. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay. Conclusion Large difficult CBDS can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay. Large difficult CBD stones can be managed either by open surgery or laparoscopically with acceptable comparable outcomes. No need for multiple ERCP sessions due to their related morbidities. Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair. Primary repair is better than T-tube regarding operative time and post-operative hospital stay.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Hazem Zakaria
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Ayman Alsebaey
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Talat Zakareya
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Mohamed Abbasy
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Anwar Mohamed
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Ali Nada
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | | | - Mohamed Housseni
- Intervention Radiology, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
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Gad EH, Zakaria H, Kamel Y, Alsebaey A, Zakareya T, Abbasy M, Mohamed A, Nada A, Abdelsamee MA, Housseni M. Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study. ANNALS OF MEDICINE AND SURGERY (2012) 2019. [PMID: 31198552 DOI: 10.1016/j.amsu.2019.05.007.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/01/2022]
Abstract
Objectives For complicated common bile duct stones (CBDS) that cannot be extracted by endoscopic retrograde cholangiopancreatography (ERCP), management can be safely by open or laparoscopic CBD exploration (CBDE). The study aimed to assess these surgical procedures after endoscopic failure. Methods We analyzed 85 patients underwent surgical management of difficult CBDS after ERCP failure, in the period from 2013 to 2018. Results Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively. An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBDE(LCBDE), open CBDE(OCBDE) and the converted cases were 24.7% (n = 21), 70.6% (n = 60), and 4.7% (n = 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively, Eleven (12.9%) of our patients had postoperative complications without mortality. By comparing LCBDE and OCBDE; there was a significant association between the former and longer operative time. On comparing, T-tube and 1ry CBD closure in both OCBDE and LCBDE, there was significantly longer operative time, and post-operative hospital stays in the former. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay. Conclusion Large difficult CBDS can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Hazem Zakaria
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Ayman Alsebaey
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Talat Zakareya
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Mohamed Abbasy
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Anwar Mohamed
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Ali Nada
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | | | - Mohamed Housseni
- Intervention Radiology, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
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Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I. Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open 2019; 3:242-251. [PMID: 31183439 PMCID: PMC6551404 DOI: 10.1002/bjs5.50132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/21/2018] [Indexed: 02/05/2023] Open
Abstract
Background It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta‐analysis, the success of LTCE versus LCD was evaluated. Methods Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud‐based platform. Random‐effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD −0·86, 95 per cent c.i. −0·97 to −0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD −0·78, −1·14 to −0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.
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Affiliation(s)
- M Bekheit
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - R Smith
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - G Ramsay
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK.,Scottish Clinical Research Excellence Development Scheme, Rowett Institute University of Aberdeen Aberdeen UK
| | - F Soggiu
- Department of Surgery Royal Free Hospital London UK
| | - M Ghazanfar
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - I Ahmed
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
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A predictive nomogram to identify factors influencing the success of a concomitant laparoscopic cholecystectomy with common bile duct exploration for choledocholithiasis. HPB (Oxford) 2018; 20:313-320. [PMID: 29100711 DOI: 10.1016/j.hpb.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Single-staged laparoscopic common bile duct exploration (LCBDE) offers clear benefits in terms of cost and shorter hospitalization stays. However, a failed LCBDE requiring conversion to open surgery is associated with increased morbidity. This study reviewed the factors determining success of LCBDE, and created a predictive nomogram to stratify patients for the procedure. METHODS A retrospective analysis of 109 patients who underwent LCBDE was performed. A nomogram was developed from factors significantly associated with conversion to open surgery and validated. RESULTS Sixty-two patients underwent a successful LCBDE, while 47 patients required a conversion to open CBDE. The presence of underlying cholangitis (crude OR 2.70, 95% CI: 1.12-6.56, p = 0.017), together with its subsequent interventions, seemed to adversely increase the rate of conversion to open surgery. The predictive factors included in the nomogram for a failed laparoscopic CBDE included prior antibiotic use (adjusted OR (AOR) 2.98, 95% CI: 1.17-7.57, p = 0.022), previous ERCP (AOR 4.99, 95% CI: 2.02-12.36, p = 0.001) and abnormal biliary anatomy (AOR 9.37, 95% CI: 2.18-40.20, p = 0.003). CONCLUSION LCBDE is useful for the treatment of choledocholithiasis. However, patients who were predicted to have an elevated risk for open conversion might not be ideal candidates for the procedure.
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Zhu H, Wu L, Yuan R, Wang Y, Liao W, Lei J, Shao J. Learning curve for performing choledochotomy bile duct exploration with primary closure after laparoscopic cholecystectomy. Surg Endosc 2018; 32:4263-4270. [PMID: 29602995 DOI: 10.1007/s00464-018-6175-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 03/21/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Primary closure after laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) is a safe and effective approach for treating cholecystolithiasis with choledocholithiasis. The aim of this study was to evaluate the learning curve of performing primary closure after LC+LCBDE. METHODS We retrospectively identified all patients who underwent primary closure after LC+LCBDE performed by a single surgeon from January 2009 to April 2015 in our institution, and analyzed preoperative, intraoperative, and postoperative data using the cumulative sum (CUSUM) analysis to evaluate the learning curve for this procedure. RESULTS Overall, there were 390 patients. The total postoperative complications rate was 7.2%, including bile leakage in 9 (2.3%) patients and retained common bile duct stone in 3 (0.8%) patients. The CUSUM operating time (OT) learning curve was best modeled by the equation: CUSUMOT = 312.209 × procedure0.599 × e(-0.011×procedure) + 122.608 (R2 = 0.96). The learning curve was composed of two phases, phase 1 (the initial 54 patients) and phase 2 (the remaining 336 patients). A significant decrease in the OT (116.8 ± 22.4 vs. 93.8 ± 17.8 min; p < 0.001) and complication rate (16.7 vs. 5.7%; p < 0.01) including the rate of bile leakage (7.4 vs. 1.5%; p < 0.01) and retained stone (3.7 vs. 0.3%; p < 0.01) was observed between the two phases. In addition, 20 patients had conversion to open surgery. Impacted stones were independently associated with conversion, as indicated by a multivariable analysis. CONCLUSION The data suggest that the learning curve of this procedure was achieved in approximately 54 cases. An impacted stone was the only risk factor that affected the conversion rate.
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Affiliation(s)
- Hengqing Zhu
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
| | - Linquan Wu
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
- Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China
| | - Rongfa Yuan
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
- Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China
| | - Yu Wang
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
| | - Wenjun Liao
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China
- Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China
| | - Jun Lei
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China.
- Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China.
| | - Jianghua Shao
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, China.
- Jiangxi Province Engineering Research Center of Hepatobiliary Disease, Nanchang, China.
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Sharma V, Malik S, Mandavdhare HS, Singh H. Successful ERCP for management of traumatic pancreatic disruption in a patient with situs inversus. Intractable Rare Dis Res 2018; 7:65-68. [PMID: 29552451 PMCID: PMC5849630 DOI: 10.5582/irdr.2017.01072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Endoscopic retrograde cholangio-pancreatography (ERCP) is an important tool for treatment of pancreaticobiliary diseases. However, ERCP may be difficult in patients who have altered gastrointestinal anatomy due to congenital or surgical reasons. A 40-year-old male with HIV infection presented with abdominal pain following abdominal trauma. The patient was diagnosed to have traumatic pancreatic injury and underlying situs inversus. The pancreatic fluid collection was drained using radiology guided pigtail placement done for the symptoms of abdominal pain and vomiting. The resulting external pancreatic fistula was successfully managed with ERCP and stenting. The patient improved with disappearance of ascites and resolution of pigtail output which was then removed. We report the technique used for ERCP in this patient. We also review the literature on pancreatic endotherapy in patients with situs inversus. The published literature suggests that with modifications in the standard ERCP technique like mirror image technique, 180 degree turn technique, left lateral technique etc. these patients can be managed successfully.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address correspondence to: Dr. Vishal Sharma, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail:
| | - Sarthak Malik
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Li KY, Shi CX, Tang KL, Huang JZ, Zhang DL. Advantages of laparoscopic common bile duct exploration in common bile duct stones. Wien Klin Wochenschr 2017; 130:100-104. [PMID: 28762058 DOI: 10.1007/s00508-017-1232-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/30/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the efficacy, safety, and surgical outcomes of laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, and open common bile duct exploration for treatment of common bile duct stones. METHODS In total, 210 patients were prospectively randomized into 3 groups: laparoscopic common bile duct exploration, endoscopic retrograde cholangiopancreatography, and open common bile duct exploration. The primary outcome measures were the common bile duct stone clearance rate and the complication rate. The secondary outcome measures were mortality, total costs, and length of hospital stay. RESULTS The success rates in the laparoscopic common bile duct exploration group (97.14%, 68 out of 70) and open common bile duct exploration group (98.57%, 69/70) were significantly higher than that in the endoscopic retrograde cholangiopancreatography group (85.71%, 60/70, both p < 0.05). The complication rates in the laparoscopic common bile duct exploration group (2.86%, 2/70) and open common bile duct exploration group (1.43%, 1/70) were significantly lower than that in the endoscopic retrograde cholangiopancreatography group (14.29%, 10/70, both p < 0.05). The success rate and complication rate were not significantly different between the laparoscopic common bile duct exploration group and open common bile duct exploration group (both p > 0.05). CONCLUSION Laparoscopic common bile duct exploration provides an alternative therapeutic approach that was safer and more reliable, allowed for earlier recovery, and provided more cost-effective treatment of common bile duct stones.
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Affiliation(s)
- Ke-Yue Li
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, 550002, Guiyang, Guizhou Province, China.
| | - Cheng-Xian Shi
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, 550002, Guiyang, Guizhou Province, China
| | - Ke-Li Tang
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, 550002, Guiyang, Guizhou Province, China
| | - Jian-Zhao Huang
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, 550002, Guiyang, Guizhou Province, China
| | - De-Lin Zhang
- Department of Hepatobiliary Surgery, Guizhou Provincial People's Hospital, 550002, Guiyang, Guizhou Province, China
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Bansal VK, Krishna A, Rajan K, Prajapati O, Kumar S, Rajeshwari S, Garg P, Misra MC. Outcomes of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography in Patients with Concomitant Gall Stones and Common Bile Duct Stones: A Prospective Study. J Laparoendosc Adv Surg Tech A 2016; 26:985-991. [DOI: 10.1089/lap.2016.0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Virinder Kumar Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Asuri Krishna
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Karthik Rajan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Omprakash Prajapati
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subodh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Subramaniam Rajeshwari
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh C. Misra
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Lei J, Wang J, Li Q, Wu P, Yuan R, Zhu H, Zou S, Shao J, Fang L. Laparoscopic Transcystic Common Bile Duct Exploration: T-Shaped Incision of Cystic Duct with FREDDY Laser Lithotripsy. J Laparoendosc Adv Surg Tech A 2016; 26:646-51. [PMID: 27139745 DOI: 10.1089/lap.2016.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Optimal laparoscopic techniques for management of gallstones concomitant with common bile duct (CBD) stones remain under debate. The aim of this study was to evaluate a novel approach to managing gallstones concomitant with large or impacted CBD stones through a modified laparoscopic transcystic CBD exploration (LTCBDE) with frequency-doubled double-pulse neodymium:YAG (FREDDY) laser lithotripsy. MATERIALS AND METHODS This retrospective review includes 32 consecutive patients with gallstones concomitant with large or impacted CBD stones who were offered LTCBDE with FREDDY laser lithotripsy between June 2012 and December 2014. Demographic, perioperative, and follow-up data were collected and analyzed retrospectively. RESULTS CBD stone clearance was achieved for all patients. There were 13 males and 19 females, among whom there were three patients with a history of abdominal surgery. The diameter of the CBD ranged from 10 to 20 (mean 15.1) mm, and the number of CBD stones ranged from 1 to 5. CBD stones ranged in diameter from 9 to 18 (mean 11.7) mm and 9 patients had stones that were impacted in the CBD. The mean operative time was 123 ± 18 minutes with a range of 72 to 155 minutes. The mean length of postoperative hospital stay was 5.3 (range 4-7) days. All patients recovered normally without morbidity or mortality. CONCLUSIONS The modified LTCBDE with a T-shaped incision of the cystic duct and FREDDY laser lithotripsy is a safe and effective means of managing gallstones concomitant with large or impacted CBD stones.
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Affiliation(s)
- Jun Lei
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Jun Wang
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Qiang Li
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Peng Wu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Rongfa Yuan
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Hengqing Zhu
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Shubing Zou
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Jianghua Shao
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
| | - Lu Fang
- Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University , Nanchang, China
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25
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Fusaroli P, Lisotti A, Syguda A, D'Ercole MC, Maimone A, Fabbri C, Cennamo V, Cecinato P, Cariani G, Caletti G. Reliability of endoscopic ultrasound in predicting the number and size of common bile duct stones before endoscopic retrograde cholangiopancreatography. Dig Liver Dis 2016; 48:277-82. [PMID: 26589108 DOI: 10.1016/j.dld.2015.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/01/2015] [Accepted: 10/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is accurate for the diagnosis of choledocholithiasis; however, data are lacking regarding the prediction of stone number and size. AIMS To evaluate the concordance between EUS and endoscopic retrograde cholangiopancreatography (ERCP) in stone number and size assessment. METHODS We performed a retrospective analysis of consecutive patients undergoing ERCP due to detection of choledocholithiasis by EUS. Concordance between EUS and ERCP was defined as difference in stone diameter <30% and perfect match in stone number. RESULTS Among 116 patients, 25% had sludge, 37.9% had single and 37.1% had multiple stones. Overall concordance was 62.9%. Sludge was correctly assessed in 85.7%, single stone in 81.3% and multiple stones in 45.1% (P=0.0001). EUS was accurate in 78.8% of patients who underwent both procedures in the same session, but only in 61.9% in those who underwent ERCP within 1 week. Multivariate analysis identified the single-session approach (odds ratio 2.894; P=0.035) and multiple stones (odds ratio 0.244; P=0.001) as independent predictors of concordance. CONCLUSIONS Concordance between EUS and ERCP was correlated to the single session approach and inversely correlated to the presence of multiple stones. EUS may predict potentially difficult ERCP allowing to plan the best treatment strategy.
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Affiliation(s)
- Pietro Fusaroli
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy.
| | - Andrea Lisotti
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Arkadiusz Syguda
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Maria Cristina D'Ercole
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
| | - Antonella Maimone
- Gastrointestinal Unit, A.O. Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Carlo Fabbri
- Gastrointestinal Unit, Maggiore Hospital, Bologna, Italy
| | | | - Paolo Cecinato
- Gastrointestinal Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Giulio Cariani
- Gastrointestinal Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Giancarlo Caletti
- Gastrointestinal Unit, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Italy
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Abstract
Background and Objectives: One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a transcystic approach for common bile duct exploration as an alternative to the existing procedures. Methods: From April 2010 to June 2012, 9 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. The main inclusion criteria included no upper abdominal surgical history and the presence of a stone measuring <5 mm. After the gallbladder was dissected free from the liver connections in a retrograde fashion, the fundus of the gallbladder was extracted via the port incision in the right epigastrium. The choledochoscope was inserted into the gallbladder through the small opening in the fundus of the gallbladder extracorporeally and was advanced toward the common bile duct via the cystic duct under the guidance of both laparoscopic imaging and endoscopic imaging. After stones were retrieved under direct choledochoscopic vision, a drainage tube was placed in the subhepatic space. Results: Of 9 patients, 7 had successful transcystic common bile duct stone clearance. A narrow cystic duct and the unfavorable anatomy of the junction of the cystic duct and common bile duct resulted in losing access to the common bile duct. No bile leakage, hemobilia, or pancreatitis occurred. Wound infection occurred in 2 patients. Transient epigastric colic pain occurred in 2 patients and was relieved by use of anisodamine. A transient increase in the amylase level was observed in 3 patients. Short-term follow-up did not show any recurrence of common bile duct stones. Conclusion: Our novel transcystic approach to laparoscopic common bile duct exploration is feasible and efficient.
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Affiliation(s)
- Dawei Chen
- Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhewei Fei
- Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xia Huang
- Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaojun Wang
- Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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ElGeidie AA. Single-session minimally invasive management of common bile duct stones. World J Gastroenterol 2014; 20:15144-15152. [PMID: 25386063 PMCID: PMC4223248 DOI: 10.3748/wjg.v20.i41.15144] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/06/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Up to 18% of patients submitted to cholecystectomy had concomitant common bile duct stones. To avoid serious complications, these stones should be removed. There is no consensus about the ideal management strategy for such patients. Traditionally, open surgery was offered but with the advent of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) minimally invasive approach had nearly replaced laparotomy because of its well-known advantages. Minimally invasive approach could be done in either two-session (preoperative ERCP followed by LC or LC followed by postoperative ERCP) or single-session (laparoscopic common bile duct exploration or LC with intraoperative ERCP). Most recent studies have found that both options are equivalent regarding safety and efficacy but the single-session approach is associated with shorter hospital stay, fewer procedures per patient, and less cost. Consequently, single-session option should be offered to patients with cholecysto-choledocholithiaisis provided that local resources and expertise do exist. However, the management strategy should be tailored according to many variables, such as available resources, experience, patient characteristics, clinical presentations, and surgical pathology.
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Zhu JG, Han W, Zhang ZT, Guo W, Liu W, Li J. Short-term outcomes of laparoscopic transcystic common bile duct exploration with discharge less than 24 hours. J Laparoendosc Adv Surg Tech A 2014; 24:302-5. [PMID: 24745979 DOI: 10.1089/lap.2013.0537] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the length of stay and discharge time for patients could benefit multiple hospital units by saving money, reducing waiting time, and providing the opportunity for more patients to be treated. However, no experience of laparoscopic transcystic common bile duct exploration (LTCBDE) with discharge less than 24 hours has been reported until now. The objective of this study was to assess the feasibility and safety of LTCBDE with discharge less than 24 hours. PATIENTS AND METHODS A retrospective review showed that 34 of 111 patients scheduled in our institution were discharged less than 24 hours after LTCBDE between June 1 and December 31, 2011. A multimodal approach including appropriate preoperative assessment, education and counseling, early postoperative oral intake, and early mobilization was carried out. Outcomes were analyzed for patient demographics, postoperative stay, operation time, intraoperative bleeding, and reasons for failed LTCBDE. RESULTS Of 111 patients admitted for LTCBDE, 34 patients were discharged within 24 hours postoperatively. This study population comprised 11 males and 23 females with a mean age of 54.6±14.7 years (range, 28-79 years). The mean postoperative stay was 20.21±0.39 hours. There were no postoperative complications or deaths during the hospital stay or at the follow-up 12 months postoperatively in these 34 patients. CONCLUSIONS LTCBDE with discharge less than 24 hours is feasible and safe in selected patients with common bile duct stones of no more than three in number and no more than 6 mm in size. The benefit of the multimodal approach and LTCBDE may be synergistic, allowing a quick recovery of gastrointestinal function.
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Affiliation(s)
- Jie-gao Zhu
- 1 Department of General Surgery, Beijing Friendship Hospital of Capital Medical University , Beijing, People's Republic of China
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Masoni L, Mari FS, Pietropaolo V, Onorato M, Meucci M, Brescia A. Laparoscopic treatment for unsuspected common bile duct stones by transcystic sphincter of Oddi pneumatic balloon dilation and pressure-washing technique. World J Surg 2014; 37:1258-62. [PMID: 23474857 DOI: 10.1007/s00268-013-1992-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Unsuspected common bile duct stones (CBDS) are found in 4-5 % of patients with cholelithiasis. The optimal strategy for the treatment of asymptomatic CBDS, diagnosed during laparoscopic cholecystectomy (LC), is not yet well established. A one-stage solution is preferable to solve the CBDS during the LC and to avoid the exposure of patients to the risks of a second procedure, such as complications or failure. METHODS We attempted to remove CBDS by transcystic sphincter of Oddi pneumatic balloon dilation and common bile duct pressure-washing in all cases of intraoperative identification of CBDS since September 2008. RESULTS In 29 cases, unsuspected CBDS was identified by intraoperative cholangiography; in 28 cases a single stone with a mean diameter of 4.3 mm (range = 3-6) was detected and in one case three 5-8-mm-diameter stones were identified. Clearance of the common bile duct was obtained in 27 cases (96 %), with a mean operative time of 54 min (range = 36-90) and mean length of hospital stay of 2.5 days. CONCLUSION Treatment of unsuspected CBDS detected by intraoperative cholangiography during LC with this original technique was safe and effective and a viable alternative of the transcystic endoscopic approach.
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Affiliation(s)
- Luigi Masoni
- Department of Medical and Surgical Sciences and Translational Medicine, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy
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Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 2013; 206:457-63. [PMID: 23871320 DOI: 10.1016/j.amjsurg.2013.02.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/26/2013] [Accepted: 02/07/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration are safe and efficient methods that have recently been used for the treatment of bile duct stones. The aim of this study was to compare the efficacy, safety, and surgical outcomes of the laparoscopic common bile duct exploration plus laparoscopic cholecystectomy (LCBDE+LC) and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy (ERCP+LC). METHODS One hundred twenty patients were prospectively randomized into 2 groups: LCBDE with LC in a single intervention and LC after ERCP. RESULTS The success rate of the LCBDE+LC group (96.5%) was found to be higher than for the ERCP+LC group (94.4%). Complication rates of the LCBDE+LC and ERCP+LC group were 7% and 11.1%, respectively. Complications requiring ERCP in the postoperative period after LCBDE+LC have been noted in 3.5% of cases. CONCLUSIONS Laparoscopic CBD exploration provides an alternative therapeutic approach that has less morbidity, is cost-effective, and allows earlier recovery with a reduced period of short-term disability.
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Treatment of common bile duct stones in Sweden 1989-2006: an observational nationwide study of a paradigm shift. World J Surg 2012; 36:2146-53. [PMID: 22610264 DOI: 10.1007/s00268-012-1648-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The preferred strategies for treatment of common bile duct stones have changed from choledochotomy with cholecystectomy to sphincterotomy with or without cholecystectomy. The aim of the present study was to compare the effectiveness of these treatment strategies on a nationwide level in Sweden. METHODS All patients with hospital care for benign biliary diagnoses 1988-2006 were identified in Swedish registers. Patients with common bile duct stones and a first admission with choledochotomy and or endoscopic sphincterotomy from 1989 through 2006 comprised the study group. These patients were analyzed with respect to readmission for biliary diagnoses and acute pancreatitis. RESULTS Incidence of open and laparoscopic choledochotomy decreased from 19.4 to 5.2, whereas endoscopic sphincterotomy increased from 5.1 to 26.1 per 100,000 inhabitants per year, respectively. Among patients treated for common bile duct stones (n = 26,815), 60.0 % underwent cholecystectomy during the first hospital admission in 1989-1994, compared to 30.1 % in 2001-2006. The treatment strategy that included endoscopic sphincterotomy was associated with more readmissions for biliary diagnoses and increased risk for acute pancreatitis than the treatment strategy with choledochotomy. However, patients treated with endoscopic sphincterotomy and concurrent cholecystectomy at the index admission had the lowest risk of readmission. CONCLUSIONS Cholecystectomy has been increasingly separated from treatment of bile duct stones, and endoscopic sphincterotomy has superseded choledochotomy as a first alternative for bile duct clearance in Sweden. In patients fit for surgery, clearance of the common bile duct can be combined with cholecystectomy, as it probably reduces the need for biliary related readmissions.
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Yun KW, Ahn YJ, Lee HW, Jung IM, Chung JK, Heo SC, Hwang KT, Ahn HS. Laparoscopic common bile duct exploration in patients with previous upper abdominal operations. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:154-9. [PMID: 26388927 PMCID: PMC4574995 DOI: 10.14701/kjhbps.2012.16.4.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 01/24/2023]
Abstract
Backgrounds/Aims We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery. Methods Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality. Results All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5±63.1 min in group A and 134.8±45.2 min in group B, p=0.18) and postoperative hospital stay (12.6±5.7 days in group A and 9.8±2.9 days in group B, p=0.158). Duct clearance and complication rates were comparable (p>0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, p=0.312) Trocar or Veress needle related complication did not occur in either group. Conclusions LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis.
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Affiliation(s)
- Keong Won Yun
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joon Ahn
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hae Won Lee
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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del Olmo López R, Geijo Martínez F, Macías Hernández N, Esteban Velasco MDC, Oliva Oliva I. [Spontaneous disappearance of «impossible to remove» calculi in the main bile duct after endoscopic sphincterotomy]. Cir Esp 2011; 90:129-31. [PMID: 21414612 DOI: 10.1016/j.ciresp.2010.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 11/02/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
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Banerjee N, Hilden K, Baron TH, Adler DG. Endoscopic biliary sphincterotomy is not required for transpapillary SEMS placement for biliary obstruction. Dig Dis Sci 2011; 56:591-5. [PMID: 20632105 DOI: 10.1007/s10620-010-1317-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 06/14/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography with biliary self-expanding metal stent placement is the preferred method of providing biliary drainage for pancreaticobiliary malignancies. Some endoscopists routinely perform biliary sphincterotomy to facilitate biliary stent placement and potentially minimize pancreatitis with transpapillary self-expanding metal stent placement. AIMS Our hypothesis was that biliary sphincterotomy has no effect on the success rate of transpapillary self-expanding metal stent placement and increases procedure-related complications. METHODS In a retrospective analysis, outcomes of two groups were compared: (1) self-expanding metal stent placement without biliary sphincterotomy, (2) self-expanding metal stent placement with biliary sphincterotomy during the same procedure. Complications and stent patency rates were evaluated. RESULTS There were 104 subjects included in the study. Post-sphincterotomy bleeding (p = 0.001) was associated with biliary sphincterotomy performed immediately prior to self-expanding metal stent placement. Importantly, self-expanding metal stent placement without biliary sphincterotomy was always technically successful and self-expanding metal stent placement without biliary sphincterotomy was not associated with pancreatitis. CONCLUSIONS Patients who undergo biliary sphincterotomy during transpapillary self-expanding metal stent placement experience more immediate complications than those who do not. Biliary sphincterotomy was not associated with longer stent patency. Self-expanding metal stent placement without a biliary sphincterotomy was not associated with pancreatitis regardless of the type of self-expanding metal stent used (covered or uncovered). Of the patients without a biliary sphincterotomy, 100% had successful stent placement, further arguing against its use in this setting.
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Affiliation(s)
- Nikhil Banerjee
- Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, UT, USA
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Sanchez A, Rodriguez O, Bellorín O, Sánchez R, Benítez G. Laparoscopic common bile duct exploration in patients with gallstones and choledocholithiasis. JSLS 2010; 14:246-50. [PMID: 20932377 PMCID: PMC3043576 DOI: 10.4293/108680810x12785289144395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Failed ERCP appears to decrease the success rate of a laparoscopic approach for common bile duct exploration. Objectives: To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). Methods: This is a descriptive, comparative study. Patients with an indication of common bile duct exploration between February 2005 and October 2008 were included. We studied 2 groups: Group A: patients with failed ERCP who underwent LCBDE plus LC. Group B: patients with common bile duct stones managed with the 1-step approach (LCBDE + LC) with no prior ERCP. Results: Twenty-five patients were included. Group A: 9 patients, group B: 16 patients. Success rate, operative time, and hospital stay were as follows: group A 66% vs group B 87.5%; group A 187 minutes vs 106 minutes; group A 4.5 days vs 2.3 days; respectively. Conclusion: Patients with failed ERCP should be considered as high-complex cases in which the laparoscopic procedure success rate decreases, and the conversion rate increases considerably.
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Affiliation(s)
- Aléxis Sanchez
- Medicine Faculty, Central University of Venezuela, Caracas, Venezuela.
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Noble H, Whitley E, Norton S, Thompson M. A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration. Surg Endosc 2010; 25:130-9. [DOI: 10.1007/s00464-010-1146-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 05/18/2010] [Indexed: 02/07/2023]
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Transcylindrical gas-free cholecystectomy for the treatment of cholelithiasis, cholecystitis, and choledocholithiasis. Surg Endosc 2010; 24:2099-104. [PMID: 20354871 DOI: 10.1007/s00464-010-0904-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has become the standard for treatment of uncomplicated cholecystolithiasis. However, in cases of cholecystitis or cholecysto-choledocholithiasis, technical and skill requirements may make questionable the convenience of laparoscopy. Transcylindrical cholecystectomy (TC) is a modified minilaparotomy, performed gas-free through a single cylinder 3.8 cm in diameter and 10.0 cm in length. Our study objective has been to assess the efficacy and potential advantages of TC in the treatment of cholelithiasis, cholecystitis, and cholecholithiasis through an efficacy, prospective, and longitudinal study. METHOD TC was carried out in 364 consecutive patients including 78 acute cholecystitis, 37 acute biliary pancreatitis, and 48 suspected choledocholithiasis. Transcystic cholangiography was selectively attempted in 74 patients (20.3%) and successfully obtained in all but one patient. Twenty-six patients (7.1%) underwent transcylindrical common duct exploration (and calculi removal) through a choledochotomy. RESULTS Operation was converted into subcostal laparotomy in other 23 patients (5.9%). In our series, there were no injuries to the main bile ducts or hemorrhagic accidents. Operating times in minutes (SD) were (i) "simple cholecystectomy" without cholangiography n = 237: 43.5 (13.3), with cholangiography n = 30: 64.2 (20.7), (ii) "cholecystitis" n = 78: 66.2 (28.7), and (iii) "choledocholithiasis" n = 26: 117.0 (24.6). Postoperative complications for the respective patients in groups i, ii, and iii were (a) wound infection: 5 (1.9%), 0 and 0; (b) bile leaks: 2 (0.75%; one causing death), 2 (0.75%) and 0; (c) reoperation for bleeding: 1 (0.4%), 0 and 1 (3.8%); and (d) residual stones in the main bile ducts: 0, 0 and 1 (3.8%). CONCLUSION TC has been proved to be applicable, efficient, and safe for the treatment of cholelithiasis and its complications.
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A decade of washing out common bile duct stones with papillary balloon dilatation as a one-stage procedure during laparoscopic cholecystectomy. Surg Endosc 2010; 24:2226-30. [PMID: 20177926 PMCID: PMC2939343 DOI: 10.1007/s00464-010-0937-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 09/17/2009] [Indexed: 11/03/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the treatment of choice for the management of cholecystolithiasis. For the management of choledocholithiasis, a number of options exist. The effectiveness of washing out common bile duct stones with laparoscopic transcystic papillary balloon dilatation (LTPBD) in patients undergoing laparoscopic cholecystectomy (LC) as a one-stage procedure was evaluated. METHODS Retrospectively, the files of 63 patients treated with LTPBD in a one-stage procedure undergoing laparoscopic cholecystectomy between December 1996 and December 2006 were studied. RESULTS Fifty-three patients were treated successfully in a one-stage procedure, seven patients were treated in two steps with an endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and in three cases a conversion to open surgery was required. The median operation time was 128 min, and the median hospital stay was 4 days. No patients developed postoperative pancreatitis. In one case contrast leakage from the common bile duct was detected. It was the only complication directly related to the LTPBD. There were no postoperative deaths. CONCLUSIONS We consider the wash out of common bile duct stones after LTPBD in a one-stage procedure to be an easy to do and safe operation with great results. Cooperation with an intervention radiologist and application of an angioplastic dilatation dotter balloon catheter are the keys to success in this procedure. In our hospital, it is the treatment of choice for choledocholithiasis associated with cholelithiasis.
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Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract 2009; 2009:840208. [PMID: 19672460 PMCID: PMC2722154 DOI: 10.1155/2009/840208] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/25/2009] [Indexed: 02/08/2023] Open
Abstract
Common bile duct stones (CBDSs) may occur in up to 3%–14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal), or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure) are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.
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LaFemina J, Sokal SM, Chang Y, McGrath D, Berger DL. Effect of medical or surgical admission on outcome of patients with gallstone pancreatitis and common bile duct stones. J Gastrointest Surg 2008; 12:1554-60. [PMID: 18622658 DOI: 10.1007/s11605-008-0580-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 06/16/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Management of uncomplicated common bile duct stone (CBDS) and gallstone pancreatitis (GP) presumably varies based on whether a patient is admitted to medicine or surgery. This study evaluates the impact of admitting team on outcome and cost. METHODS Three hundred seventy patients admitted to the Massachusetts General Hospital for CBDS or GP were retrospectively analyzed for demographics, insurance status, procedures, complications, length of stay, readmission, and cost. A multivariable analysis was conducted for outcome and cost measures. RESULTS Patients admitted to a surgical service were younger than those admitted to a medical service. Gender, race, tobacco use, and the presence of chronic obstructive pulmonary disease and chronic renal insufficiency were not significantly different between groups. Patients admitted to a medical service had a higher incidence of coronary artery disease and diabetes. Despite lower readmission rates for surgical patients, there was no difference in total hospital days between groups. Though total cost of an initial surgical admission was greater than a medical admission, total cost attributable to the index admission diminished over time and ultimately was not significant in follow-up. CONCLUSIONS Despite variations in uncomplicated management of CBDS and GP, there is no difference, in long-term follow-up, in the total number of hospital days or cost for the management of CBDS or GP based on admitting team practices.
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Affiliation(s)
- Jennifer LaFemina
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Gholipour C, Shalchi RA, Abassi M. Efficacy and safety of early laparoscopic common bile duct exploration as primary procedure in acute cholangitis caused by common bile duct stones. J Laparoendosc Adv Surg Tech A 2008; 17:634-8. [PMID: 17907977 DOI: 10.1089/lap.2006.0199] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The elective laparoscopic management of common bile duct (CBD) stones is widely accepted; however, the urgent laparoscopic exploration of common bile duct (LCBDE) within the first 72 hours of acute cholangitis is not assessed extensively. Our aim was to study the safety and efficacy of urgent LCBDE in patients with acute cholangitis. MATERIALS AND METHODS In a single-center prospective study, 73 patients of a university hospital with acute gallstone cholangitis were operated on with laparoscopy or open surgery, based on a predetermined schedule concerning the presence of the skilled laparoscopic surgeon at the hospital. Patients with sever acute cholangitis (e.g., organ failure, shock, or peritonitis), pancreatitis, and suspected tumoral obstructions were excluded. The major outcomes, including mortality, complications of surgery, and the length of hospital and intensive care unit (ICU) stay, are reported in this paper. RESULTS In all 36 open surgery patients, a choledocotomy and T-tube placement procedure were performed. In laparoscopic patients, CBD clearance was approached by a transcystic and choledocotomy approach in 15 and 22 subjects, respectively. Eight (6 in the open and 2 in the laparoscopic group) choledocoduodenostomies were performed. Cholangitis was controlled sufficiently in all patients. Of 37 laparoscopies, 3 operations were converted into open surgeries. Operation time was longer in the laparoscopic group, compared to the open group (201 +/- 15 vs. 146 +/- 6.1 minutes; P < 0.01). The average ICU and hospital stay after an operation were significantly less than open surgery group. Total cost of treatment in laparoscopic group was less than 75% of that of the open surgery group. General complications were more common in the open surgery group. There was no mortality. One retained stone was discovered in the laparoscopic group. CONCLUSIONS Early one-stage LCBDE is an effective procedure as an initial and definite management of acute gallstone cholangitis, which prevents a second hospitalization and relapse problems.
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Affiliation(s)
- Changiz Gholipour
- Department of General Surgery, Sinaea Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Abstract
At the moment, therapeutic splitting is still regarded by the vast majority of surgeons as the gold standard for stones in the common bile duct. Endoscopic clearance of the duct certainly is much less invasive than open exploration. However, this does not apply when compared with laparoscopic stone removal. Both are equivalent in respect to stone clearance rates, but the laparoscopic techniques protect patients from the long-term sequelae of endoscopic papillotomy. This can be important particularly for younger patients. Laparoscopic bile duct exploration is cost-effective and safe. Special experience in laparoscopic surgical techniques, however, is mandatory. Thus, surgeons should intensify their training in laparoscopic bile duct exploration in order to increase the acceptance of these techniques.
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Affiliation(s)
- U T Hopt
- Abteilung Allgemein- und Viszeralchirurgie, Chirurgische Universitätsklinik Freiburg, Hugstetterstrasse 55, 79106 Freiburg.
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Yau KK, Chung CC, Wong JCH, Li MKW. Minimally invasive operating suite in the 21st century: Endo-Lap operating room. SURGICAL PRACTICE 2006. [DOI: 10.1111/j.1744-1633.2006.00307.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tang CN, Li MKW. Technical aspects in the laparoscopic management of complicated common bile duct stones. ACTA ACUST UNITED AC 2005; 12:444-50. [PMID: 16365816 DOI: 10.1007/s00534-005-1029-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/28/2005] [Indexed: 12/21/2022]
Abstract
The management of common bile duct (CBD) stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of last century, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) has become the mainstream treatment for CBD stones and gallstones in most medical centers around the world. However, in certain situations, ERCP cannot be feasible because of difficult cannulation and extraction. ERCP can also be associated with potential serious complications, in particular for complicated stones requiring repeated sessions and additional maneuvers. Since our first laparoscopic exploration of the CBD (LECBD) in 1995, we now adopt the routine practice of the laparoscopic approach in dealing with endoscopically irretrievable CBD stones. The aim of this article is to describe the technical details of this approach and to review the results from our series.
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Affiliation(s)
- Chung-Ngai Tang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chai Wan, Hong Kong
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