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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [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: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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2
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Zhu J, Wu H, Liu K, Wang D, Guo W, Zhang Z. Diagnostic performance of laparoscopic transcystic common bile duct exploration for the detection of choledocholithiasis in patients with negative MRCP. Updates Surg 2023; 75:1887-1891. [PMID: 37204658 DOI: 10.1007/s13304-023-01524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
There is little research to evaluate laparoscopic transcystic common bile duct (CBD) exploration (LTCBDE) as a diagnostic test to identify choledocholithiasis undergoing laparoscopic cholecystectomy (LC). This study aimed to assess the technical success and safety of LTCBDE in patients with suspected choledocholithiasis but negative magnetic resonance cholangiopancreatography (MRCP) undergoing LC. We did an ambispective cohort study in patients with gallstones and suspected CBD stones but negative MRCP undergoing LC. The primary outcomes were the rate of complications in the hospital. Between January 2010 and December 2018, 620 patients (median age, 58 years; 58.4% female) were eligible for the study. The success rate of LTCBDE was 91.8% and CBD stones were observed in 53.3% with a stone clearance rate of 99.3%. The overall postoperative complication rate was 0.65% and no death was recorded in the total cohort. Notably, the morbidity in LTCBDE is 0.53%. Retained CBD stones were diagnosed in 2 patients and managed by ERCP successfully. In the LTCBDE cohort, the median duration of operation was 78 (60-100) min and the median postoperative hospital stay was 1 (1-2) days. Overall, at a mean follow-up of 4.1 (2.3-6.1) years, recurrent CBD stones occurred in 1.1% and all-cause mortality in 0.6%. LTCBDE should be considered the favored choice in the diagnostic algorithm for patients with suspected choledocholithiasis but negative MRCP undergoing LC.
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Affiliation(s)
- Jiegao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China.
- National Clinical Research Center for Digestive Diseases, Beijing, China.
| | - Hongwei Wu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Kun Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China.
- National Clinical Research Center for Digestive Diseases, Beijing, China.
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xi-Cheng District, Beijing, 100050, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
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Mauro A, Mazza S, Scalvini D, Lusetti F, Bardone M, Quaretti P, Cobianchi L, Anderloni A. The Role of Cholangioscopy in Biliary Diseases. Diagnostics (Basel) 2023; 13:2933. [PMID: 37761300 PMCID: PMC10528268 DOI: 10.3390/diagnostics13182933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Endoscopy plays a central role in diagnostic and therapeutic approaches to biliary disease in both benign and malignant conditions. A cholangioscope is an endoscopic instrument that allows for the direct exploration of the biliary tree. Over the years, technology has improved endoscopic image quality and allowed for the development of an operative procedure that can be performed during cholangioscopy. Different types of instruments are available in this context, and they can be used in different anatomical access points according to the most appropriate clinical indication. The direct visualization of biliary mucosa is essential in the presence of biliary strictures of unknown significance, allowing for the appropriate allocation of patients to surgery or conservative treatments. Cholangioscopy has demonstrated excellent performance in discriminating malignant conditions (such as colangiocarcinoma) from benign inflammatory strictures, and more recent advances (e.g., artificial intelligence and confocal laser endomicroscopy) could further increase its diagnostic accuracy. Cholangioscopy also plays a primary role in the treatment of benign conditions such as difficult bile stones (DBSs). In this case, it may not be possible to achieve complete biliary drainage using standard ERCP. Therapeutic cholangioscopy-guided lithotripsy allows for stone fragmentation and complete biliary drainage. Indeed, other complex clinical situations, such as patients with intra-hepatic lithiasis and patients with an altered anatomy, could benefit from the therapeutic role of cholangioscopy. The aim of the present review is to explore the most recent diagnostic and therapeutic advances in the roles of cholangioscopy in the management of biliary diseases.
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Affiliation(s)
- Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Stefano Mazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Davide Scalvini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Lusetti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Marco Bardone
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
| | - Pietro Quaretti
- Unit of Interventional Radiology, Department of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (A.A.)
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Zaigham H, Enochsson L, Ottosson J, Regnér S. Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:882-888. [PMID: 36870871 DOI: 10.1016/j.soard.2023.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/30/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Treatment of common bile duct (CBD) stones after Roux-en-Y gastric bypass (RYGB) poses a particular challenge given the altered anatomy and inability to perform a standard endoscopic retrograde cholangiogram (ERC). The optimal treatment strategy for intraoperatively encountered CBD stones in post-RYGB patients has not been established. OBJECTIVES To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients. SETTING Swedish nationwide multi-registry study. METHODS The Swedish Registry for Gallstone Surgery and ERCs, GallRiks (n = 215,670), and the Scandinavian Obesity Surgery Registry (SOReg) (n = 60,479) were cross-matched for cholecystectomies with intraoperatively encountered CBD stones in patients with previous RYGB surgery between 2011 and 2020. RESULTS Registry cross-matching found 550 patients. Both LTCBDE (n = 132) and transgastric ERC (n = 145) were comparable in terms of low rates of intraoperative adverse events (1% versus 2%) and postoperative adverse events within 30 days (16% versus 18%). LTCBDE required significantly shorter operating time (P = .005) by on average 31 minutes, 95% confidence interval (CI) [10.3-52.6], and was more often used for smaller stones <4 mm in size (30% versus 17%, P = .010). However, transgastric ERC was more often used in acute surgery (78% versus 63%, P = .006) and for larger stones >8 mm in size (25% versus 8%, P < .001). CONCLUSIONS LTCBDE and transgastric ERC have similarly low complication rates for clearance of intraoperatively encountered CBD stones in RYGB-operated patients, but LTCBDE is faster while transgastric ERC is more often used in conjunction with larger bile duct stones.
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Affiliation(s)
- Hassan Zaigham
- Section of Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sara Regnér
- Section of Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
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Huang J, Hu W, Liu J, Tang X, Fan Y, Xu L, Liu T, Xiong H, Li W, Fu X, Liang B, Fang L. Laparoscopic Transcystic Common Bile Duct Exploration: 8-Year Experience at a Single Institution. J Gastrointest Surg 2023; 27:555-564. [PMID: 36652180 DOI: 10.1007/s11605-023-05594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic transcystic common bile duct exploration (LTCBDE) is used to treat cholecystolithiasis and choledocholithiasis. This study aimed to investigate the safety, effectiveness and generalisability of LTCBDE in patients with cholecystolithiasis and choledocholithiasis based on our LTCBDE experience within 8 years. METHODS Four hundred patients with cholecystolithiasis and choledocholithiasis (including 62 of cholecystolithiasis and choledocholithiasis with common bile duct no-dilatation) treated with LTCBDE at a single centre from January 2014 to February 2022 were retrospectively evaluated. They were divided into the first 200 and last 200 LTCBDE cases. The disease characteristics, cystic duct incision methods, surgical outcomes and follow-up data were analysed retrospectively. Each patient was followed up for > 3 months. RESULTS Four hundred patients underwent LTCBDE, including 188 males and 212 females aged from 15 to 91 years (average age: 56 years). LTCBDE was successful in 377 (94.3%) patients, while treatment was converted to laparoscopic choledocholithotomy with T-tube drainage in 23 (5.8%), owing to intraoperative choledochoscope insertion failure. The CBD diameter (10.89 ± 1.76 vs 9.97 ± 2.39, P < 0.05), cystic duct diameter (4.62 ± 1.03 vs 5.03 ± 1.29, P < 0.05), and operation time (164.60 ± 24.30 vs 135.34 ± 30.00, P < 0.05). Residual stones were found in six (1.5%) patients and removed during the second operation; post-operative bile leakage was found in one (0.3%) patient, who was discharged safely after the second operation. CONCLUSIONS Phase I LTCBDE is safe and effective in treating cholecystolithiasis and choledocholithiasis. With continuous technological advances, LTCBDE has been effectively promoted and applied.
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Affiliation(s)
- Jian Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Wei Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Jinghang Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Xinguo Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Yuting Fan
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Liangzhi Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Tiande Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Hu Xiong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Wen Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Xiaowei Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Bo Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - Lu Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
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Al-Ardah MI, Barnett RE, Rotennburg H, Maitland LE, Clarke MG, Clark J, Cota AM, Peyser PM, Finlay IG. Index admission vs elective laparoscopic common bile duct exploration: a district general hospital experience over 6 years. Langenbecks Arch Surg 2023; 408:32. [PMID: 36645510 DOI: 10.1007/s00423-023-02773-z] [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: 08/14/2022] [Accepted: 12/12/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) is relatively a new approach for clearing choledocholithiasis. The aim of this study is to assess the safety of this approach to clearing common bile duct (CBD) stones on an index admission including emergency setting. METHODS Retrospective data collection and analysis were carried out for 207 consecutive cases of LCBDE performed in Royal Cornwall Hospital over 6 years (2015-2020). Patients were divided into two groups (Index admission vs elective) then both groups compared. RESULTS A total of 207 cases of LCBDE were performed in our unit during the time period. One hundred twenty-two operations were performed on the index admission and 85 on a subsequent elective list. Mean operative time was 146 ± 64 min in the index admission group and 145 ± 65 min in the elective group (p = 0.913). Length of stay post-operatively was 3.3 ± 6.3 days in the index admission cases and 3.5 ± 4.6 days after elective cases. Successful clearance was achieved at the end of the operation in 116 patients in the index admission group, clearance failed in one case and negative exploration in 5 patients. In the elective group 83 patients had a successful clearance at the end of the operation, and 2 patients has had a negative exploration. Twelve patients (index admission group) and 8 patients of the elective cases required post-operative Endoscopic Retrograde Cholangiopancreatography (ERCP) to manage retained stones, recurrent stones and bile leak (p = 0.921). Three patients required re-operation for post-operative complications in each group. CONCLUSION Common bile duct exploration in index admission is safe with high success rate if performed by well-trained surgeons with advanced laparoscopic skills.
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Affiliation(s)
- Mahmoud I Al-Ardah
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK.
| | | | - Hannah Rotennburg
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Louise E Maitland
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Michael G Clarke
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - James Clark
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Allwyn M Cota
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Paul M Peyser
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Ian G Finlay
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
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Kohga A, Suzuki K, Okumura T, Yamashita K, Isogaki J, Kawabe A, Muramatsu K, Kimura T. Presence of cystic duct stone is a risk for postoperative retained stones in patients with acute cholecystitis. Clin Imaging 2022; 89:55-60. [PMID: 35704962 DOI: 10.1016/j.clinimag.2022.06.001] [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: 03/21/2022] [Revised: 05/06/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE Retained stones (RS) in the common bile duct (CBD) are one of the major problems after laparoscopic cholecystectomy and usually require endoscopic treatment. However, few reports have investigated risk factors for the development of RS in the CBD. METHODS A total of 325 patients with acute cholecystitis underwent laparoscopic cholecystectomy at our hospital between January 2013 and Jury 2021. Patient characteristics, including radiographic factors and perioperative outcomes, were reviewed, and perioperative factors predicting RS in the CBD were investigated. RESULTS RS in the CBD were developed in 34 patients. All 34 patients were treated endoscopically. ASA-PS class 3 or more (p = 0.029, odds ratio = 2.601), subtotal cholecystectomy performance (p = 0.004, odds ratio = 3.783) and the presence of cystic duct stones (p < 0.001, odds ratio = 11.759) were found by logistic regression analysis to be independent risk factors for developing RS in the CBD. Cystic duct stones were preoperatively detected in 60 patients. Of these, 21 cases were not detected on magnetic resonance cholangiopancreatography (MRCP) but on CT, while 15 cases were not detected on CT but on MRCP. CONCLUSIONS The presence of cystic duct stones on preoperative CT or MRCP is a crucial risk factor for developing RS in the CBD. Both CT and MRCP are useful to avoid overlooking cystic duct stones.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan.
| | - Kenji Suzuki
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | | | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Katsuaki Muramatsu
- Division of Radiology, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Taizo Kimura
- Division of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
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Liu Y, Yang T, Liu JH, Meng X, Xia HT. Analysis of Laparoscopic Ultrathin Choledochoscope Curative Effect on Common Bile Duct Exploration and Choledocholithotomy in 47 Cases. Front Surg 2022; 9:782357. [PMID: 35433814 PMCID: PMC9008139 DOI: 10.3389/fsurg.2022.782357] [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: 09/24/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The aim of the present study is to summarize the experience of using a 2. 7 mm choledochoscope for laparoscopic cholecystectomy combined with an ultrathin choledochoscope for common bile duct exploration and choledocholithotomy in the treatment of cholecystolithiasis associated with choledocholithiasis after the implementation of strict inclusion and exclusion criteria. Methods A retrospective analysis of 47 patients with cholecystolithiasis complicated with choledocholithiasis who were treated in the hepatopancreatobiliary surgery department of the Chinese People's Liberated Army General Hospital between January 2015 and December 2019 was performed in the present study. Clinical data of laparoscopic cholecystectomy combined with ultrathin choledochoscope transcystic duct exploration for common bile duct and choledocholithotomy. Results All 47 patients completed the operation successfully. The gallbladder duct was closed using a surgical clamp. Only 2 patients were administered with an abdominal drainage tube. The operation time was 50-160 min, the intraoperative blood loss was 5-50 ml, and the postoperative hospital stay was 2-8 days. No patients had serious complications, such as bile leakage, postoperative bleeding, cholangitis, biliary pancreatitis, and wound infection. Minor complications, such as abdominal pain (Abdominal pain was defined as a patient felt tolerable or unbearable abdominal pain but improved or disappeared with medication) and diarrhea, were present in a few patients; these improved after conservative treatment. There was no recurrence of calculi during the 1-5 years of follow-up, and the patient quality of life was good. Conclusion Laparoscopic cholecystectomy combined with ultrathin choledochoscope common bile duct exploration and choledocholithotomy is a safe and effective method after adopting strict inclusion and exclusion criteria. This technology was started in the First Medical Center, Chinese People's Liberation Army General Hospital in September 2009, and it has become extremely mature in the past 5 years.
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Affiliation(s)
- Yang Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tao Yang
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jia-Hong Liu
- Department of Hepatobiliary Surgery, Weifang Traditional Chinese Medicine Hospital, Weifang, China
| | - Xuan Meng
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hong-Tian Xia
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Zhu J, Han W, Zhang Z, Guo W. Microincision of the Cyst Duct Is Safe and Effective for the Failed Laparoscopic Transcystic Common Bile Duct Exploration. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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Song Y, Qin G, Du L, Hu H, Han Y. In vitro and in vivo assessment of biocompatibility of AZ31 alloy as biliary stents: a preclinical approach. Arch Med Sci 2022; 18:195-205. [PMID: 35154540 PMCID: PMC8826861 DOI: 10.5114/aoms.2020.92675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Biomaterial technology due to its lack of or minimal side effects in tissues has great potential. Traditionally biomaterials used were cobalt-chromium, stainless steel and nitinol alloys. Biomaterials such as magnesium (Mg) and zinc (Zn) have good biocompatibility and consequently can be a potential material for medical implants. To date, the effects of AZ31 alloy stent on cell apoptosis are still unclear. The current investigation was designed to determine the effect of AZ31 alloy stent on necrosis and apoptosis of common bile duct (CBD) epithelial cells. MATERIAL AND METHODS We experimented with application of different concentrations of AZ31 alloy stent to primary mouse extrahepatic bile epithelial cells (MEBECs) and estimated the effect on apoptosis and necrotic cells. Apoptosis and pro-apoptosis expression were estimated through real-time PCR. For in vivo protocol, we used rabbits, implanted the AZ31 bile stent, and estimated its effect on the CBD. AZ31 (40%) concentration showed an effect on the apoptotic and necrotic cells. RESULTS Real-time PCR revealed that AZ31 (40%) concentration increased the apoptotic genes such as NF-κB, caspase-3, Bax and Bax/Bcl-2 ratio as compared to the control group. In the in vivo experiment, AZ31 alloy stents were implanted into the CBD and showed an effect on the alteration the hematological, hepatic and non-hepatic parameters. CONCLUSIONS To conclude, it can be stated that AZ31 induces apoptosis via alteration in genes including nuclear factor kappa-B (NF-κB), caspase-3, Bax and Bax/Bcl-2 ratio and improved the hematological, hepatic and non-hepatic parameters.
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Affiliation(s)
- Yong Song
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Gaoping Qin
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Lixue Du
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Haitian Hu
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Yong Han
- Material Science and Engineering, Xi’an Jiaotong University, Beilin District, Xi’an, Shaanxi, China
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Bhardwaj AM, Trehan KK, Sharma V. Laparoscopic common bile duct exploration after failed endoscopic retrograde cholangio-pancreatography: Our patient series over a period of 10 years. J Minim Access Surg 2021; 18:533-538. [PMID: 35046176 PMCID: PMC9632703 DOI: 10.4103/jmas.jmas_207_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aim: Laparoscopic CBD exploration (LCBDE) for Common bile duct (CBD) stones with laparoscopic cholecystectomy (LC) is an alternative to open CBD exploration, in patients with failed endoscopic retrograde cholangio-pancreatography (ERCP). It is being performed at few centres with adequate surgical expertise. Herein, we present our experience of LCBDE with LC over a period of 10 years. Patients and Methods: A retrospective analysis of prospectively recorded data of 121 consecutive patients was performed from February 2010 to November 2019, who underwent LC and LCBDE by choledochotomy in a single surgical unit. These included all patients with failed pre-operative ERCP. Results: Out of 121 patients, LCBDE successfully cleared the CBD in 118, and three patients were converted to open surgery. All these patients underwent choledochotomy for adequate exploration of CBD. T-tube closure of CBD was performed in 103 patients and removed after a mean of 14.6 ± 2.4 days. Primary closure was performed in 15 patients. The mean hospital stay post-procedure was 3.4 ± 0.7 days. Complete ductal clearance was achieved in 115 patients, and residual stone fragments reported in three patients were removed by ERCP. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis or cholangitis. There was no 30-day mortality and no recurrent stones reported with a mean follow-up of 12.4 ± 3.9 months. Conclusion: With adequate surgical expertise, LCBDE is a feasible alternative to open surgery for CBD stones after failed ERCP with early recovery and low morbidity.
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Affiliation(s)
- Arun M Bhardwaj
- Department of General and Laparoscopic Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Kamal K Trehan
- Department of General and Laparoscopic Surgery, Max Super Speciality Hospital, New Delhi, India
| | - Vishwas Sharma
- Department of General and Laparoscopic Surgery, Max Super Speciality Hospital, New Delhi, India
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Bosley ME, Zamora IJ, Neff LP. Choledocholithiasis-a new clinical pathway. Transl Gastroenterol Hepatol 2021; 6:35. [PMID: 34423156 DOI: 10.21037/tgh-20-172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/18/2020] [Indexed: 01/07/2023] Open
Abstract
The incidence of cholecystectomy in children has increased considerably since the early 1990s. Management of gallbladder disease in children must include an awareness of choledocholithiasis treatment strategies. Both endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct exploration (open or laparoscopic) are accepted management techniques for choledocholithiasis. Laparoscopic cholecystectomy with preoperative or postoperative ERCP is at least a two-procedure process while cholecystectomy with laparoscopic common bile duct exploration (LCBDE) can provide definitive treatment in a single procedure under one anesthetic. Despite this, the trend over the last decade continues towards less LCBDE utilization in favor of ERCP. This trend has resulted in decreased familiarity with LCBDE by adult and pediatric surgeons and their trainees. Access to the necessary tools and education on the technical aspects can allow for successful single-stage treatment of choledocholithiasis by surgeons during laparoscopic cholecystectomy. This may include a pre-defined stepwise algorithm and understanding of all the equipment and resources necessary to perform a LCBDE. Ultimately, increased understanding of the equipment and procedural steps necessary for LCBDE will result in widened adoption of the technique and thus confer advantages to the patient such as decreased length of stay and fewer required anesthetics.
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Affiliation(s)
- Maggie E Bosley
- General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Irving J Zamora
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lucas P Neff
- Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Dual common bile duct examination with transcystic choledochoscopy and cholangiography in laparoscopic cholecystectomy for suspected choledocholithiasis: a prospective study. Surg Endosc 2020; 35:3379-3386. [PMID: 32648039 DOI: 10.1007/s00464-020-07779-y] [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: 03/09/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Detection of common bile duct (CBD) stones is a major objective of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC). We evaluated the feasibility and safety of the routine use of transcystic choledochoscopy following IOC (dual common bile duct examination: DCBDE), which may improve the diagnostic accuracy of CBD stones and facilitate one-stage clearance, in LC for suspected choledocholithiasis. METHODS Between May 2017 and November 2018, 38 patients with suspected choledocholithiasis were prospectively enrolled in this study, regardless of whether they underwent endoscopic sphincterotomy. Transcystic choledochoscopy was routinely attempted following IOC in LC. RESULTS Five cases were excluded due to cholecystitis, bile duct anomaly, or liver cirrhosis. DCBDE was performed in the remaining 33 patients. The biliary tree was delineated by IOC in all patients. Subsequently, choledochosope was performed in 32 patients except for one who was found to have pancreaticobiliary malunion in IOC. The scope was successfully passed into the CBD in 25 (78.1%) patients. Choledochoscopy detected 3 (9.4%) cases of cystic duct stones and 4 (12.5%) cases of CBD stones which were not identified by IOC. All those stones were removed via cystic duct. There were no intra- and postoperative complications, except for two cases of wound infection and one case of a transient increase in serum amylase. CONCLUSIONS DCBDE in LC is a safe and promising approach for intraoperative diagnosis and one-stage treatment of suspected choledocholithasis.
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Management of bile duct stones at cholecystectomy: an Australian single-centre experience over 2 years. Surg Endosc 2020; 35:1247-1253. [PMID: 32152676 DOI: 10.1007/s00464-020-07495-7] [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: 11/01/2019] [Accepted: 03/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bile duct stones with an intact gallbladder can be treated with either bile duct exploration at cholecystectomy or endoscopic retrograde cholangiopancreatography (ERCP) before or after cholecystectomy. The aim of this study was to evaluate the management of bile duct stones at cholecystectomy at our institution. We also aimed to identify risk factors for failure of ductal clearance in our series. METHODS A retrospective review of 690 laparoscopic cholecystectomies over a 2-year period was performed. Patients who underwent laparoscopic bile duct exploration formed the study population. RESULTS Of 69 patients with suspected bile duct stones at cholecystectomy 67 (97%) patients underwent laparoscopic bile duct exploration upfront. Complete ductal clearance was achieved in 52 (78%) patients. Postoperative complications (10/67, 15%) included postoperative bleeding (2/67, 3%), bile leak (1/67, 1%), and superficial wound infection (1/67, 1%). There was no mortality. The mean operative time was 126 min and the median length of stay was 2 (1-4) days. A wider common bile duct (CBD) (≥ 8 mm) increased the risk of failed ductal clearance (OR 4.50; 95% confidence interval (CI) 1.15-19.23). CONCLUSION This study found that laparoscopic bile duct exploration can effectively and safely treat bile duct stones suspected at cholecystectomy.
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Zhou Y, Zha WZ, Fan RG, Jiang GQ, Wu XD. Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:176-181. [PMID: 30507246 DOI: 10.17235/reed.2018.5822/2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. METHODS a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. RESULTS the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. CONCLUSIONS the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.
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Affiliation(s)
- Yong Zhou
- General Surgery, Yancheng City NO.1 People's Hospital, china
| | | | | | - Guo-Qin Jiang
- The Second Affiliated of Hospital of Soochow University
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16
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Zhu JG, Wu S, Feng Q, Li F, Han W, Xiu D, Tan H, Fu J, Li X, Shang D, Liu H, Li B, Yang L, Kong Y, Zhan S, Guo W, Zhang ZT. Protocol for the CREST Choles (Chinese REgistry Study on Treatment of Cholecysto-Choledocholithiasis) study: an ambispective, multicenter, observational, open-cohort study. BMJ Open 2019; 9:e030293. [PMID: 31767583 PMCID: PMC6887007 DOI: 10.1136/bmjopen-2019-030293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The best approach for choledocholithiasis remains a matter of debate. Choledocholithiasis is usually treated with endoscopic sphincterotomy (EST), laparoscopic common bile duct exploration (LCBDE) or laparoscopic transcystic common bile duct exploration (LTCBDE). Data pertaining to the clinical outcomes of these approaches in the management of patients with cholecysto-choledocholithiasis in China are limited. An analysis of the economic burden associated with these treatments is lacking. The Chinese REgistry Study on the Treatment of Cholecysto-Choledocholithiasis (CREST Choles) was designed to address these issues in a real-world setting. METHODS AND ANALYSIS CREST Choles was an ambispective, multicenter, observational, open-cohort study. A total of 2700 patients undergoing one of the three treatments (EST+laparoscopic cholecystectomy (LC), LCBDE+LC and LTCBDE+LC) during the period from 1 January 2013 to 1 December 2018 at participating centres were enrolled in the study. Patients with gallstones and confirmed common bile duct stones were included. Data pertaining to demographics, disease history, procedural details, imaging features and follow-up were collected. Follow-up was conducted at least 6 months after enrolment in the study and annual follow-up will be conducted until December 2020. The primary outcome is the rate of adverse outcomes within 3 years postoperatively. Economic analysis (eg, incremental cost-effectiveness ratio) would be performed to compare expense across treatments. ETHICS AND DISSEMINATION Ethical approval was obtained at all participating centres. The registry presented is the first attempt to comprehensively evaluate the cost of treatment for cholecysto-choledocholithiasis in China. Findings are expected to be available in 2020 and will facilitate clinical decision making in such cases. TRIAL REGISTRATION NUMBER NCT02554097.
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Affiliation(s)
- Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
- Beijing Institute of Clinical Medicine, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center for Digestive Diseases, Beijing, China
- Clinical Epidemiology and Evidence-Based Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiushi Feng
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Han
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Haidong Tan
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianzhu Fu
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xun Li
- Department of General Surgery, The First Hospital of LanZhou University, Lanzhou, China
| | - Dong Shang
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Li Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Yuanyuan Kong
- National Clinical Research Center for Digestive Diseases, Beijing, China
- Clinical Epidemiology and Evidence-Based Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wei Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
- Beijing Institute of Clinical Medicine, Beijing, China
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research, Beijing, China
- National Clinical Research Center for Digestive Diseases, Beijing, China
- Beijing Institute of Clinical Medicine, Beijing, China
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Czerwonko ME, Pekolj J, Uad P, Mazza O, Sanchez-Claria R, Arbues G, de Santibañes E, de Santibañes M, Palavecino M. Laparoscopic Transcystic Common Bile Duct Exploration in the Emergency Is as Effective and Safe as in Elective Setting. J Gastrointest Surg 2019; 23:1848-1855. [PMID: 30421117 DOI: 10.1007/s11605-018-4029-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/22/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Emergent laparoscopic transcystic common bile duct exploration (LTCBDE) has been reported to be on the increase in some institutions, reflecting the growing confidence with the technique. However, no study has focused on the outcomes of LTCBDE in the non-elective setting. The aim of this study is to investigate whether LTCBDE can be performed effectively and safely in the emergency. METHODS This is a retrospective study of 500 consecutive patients with choledocholithiasis subjected for LTCBDE at the Hospital Italiano de Buenos Aires from January 2009 to January 2018. Procedures were classified according to the setting as emergent or elective. Demographic data and perioperative parameters were compared between groups. RESULTS Throughout the period comprised, 500 patients were admitted for choledocholithiasis and gallstones. A single-step treatment combining LTCBDE and laparoscopic cholecystectomy was attempted: 211 (42.2%) were performed electively and the 289 (57.8%) as an emergency. There was no significant difference in the success rate of LTCBDE (93.9% versus 93.8%, p = 0.975) for the two groups. The operative time was slightly longer in the emergency group (122 ± 63 versus 106 ± 53 min, p = 0.002). Postoperative recovery was slower in the emergency group, as reflected by a higher rate of prolonged postoperative stay (21.1% vs 5.7%, p < .001). The rates of postoperative complications were similar between groups (2.8% vs 5.9%, p = 0.109). CONCLUSION Emergent LTCBDE can be performed with equivalent efficacy and morbidity when compared to an elective procedure. Patients undergoing emergent procedures have longer procedures and hospital stays.
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Affiliation(s)
- Matias E Czerwonko
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Pedro Uad
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez-Claria
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín Palavecino
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina.
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Predictors of Failed Transcystic Laparoscopic Common Bile Duct Exploration: Analysis of Multicenter Integrated Health System Database. J Laparoendosc Adv Surg Tech A 2019; 29:360-365. [DOI: 10.1089/lap.2018.0360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Copeland D, Blears EE, Zhu Z, Nguyen A, Van Husen R. Novel Technique for Laparoscopic Common Bile Duct Exploration Using Endovascular Instrumentation. Cureus 2019; 11:e4041. [PMID: 31011503 PMCID: PMC6456357 DOI: 10.7759/cureus.4041] [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] [Indexed: 11/20/2022] Open
Abstract
Treatment of choledocholithiasis is sometimes a two-step process involving both surgeons and gastroenterologists. Common bile duct (CBD) exploration can be performed at the same time as cholecystectomy but often requires the use of rigid tools, increasing the risk of CBD damage. Here, we report the case of a 64-year-old man who presented with epigastric pain and a positive Murphy's sign. Ultrasonography revealed cholecystitis with cholelithiasis. Gangrenous cholecystitis was visualized upon surgical exploration, and an intraoperative cholangiogram diagnosed likely choledocholithiasis. Cholecystectomy was completed, and CBD exploration was performed by the manipulation of endovascular equipment using a trans-cystic approach through to the ampulla of Vater, and the patient made a complete recovery without complications. The substantial flexibility, gentleness, and durability of endovascular instruments allow for minimal tension on structures during the removal of gallstones from the CBD, providing safe, definitive treatment for choledocholithiasis during cholecystectomy.
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Affiliation(s)
| | | | - Zhihao Zhu
- Miscellaneous, University of Texas Medical Branch, Galveston, USA
| | - Anthony Nguyen
- Neurosurgery, University of Texas Medical Branch, Galveston, USA
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Memba R, González S, Coronado D, González V, Mata F, Rodríguez JA, Mühlenberg C, Sala J, Ribas R, Pueyo E, Mata A, O'Connor DB, Conlon KC, Jorba R. Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital. Surgeon 2019; 17:351-359. [PMID: 30704859 DOI: 10.1016/j.surge.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment. METHODS A prospective cohort study of patients diagnosed with cholelithiasis and choledocholithiasis who were treated with the single-stage treatment - transcystic instrumentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) - between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate. RESULTS 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after "flushing" in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients (16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. CONCLUSIONS Single-stage approach is a safe and effective management option for concomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a transcystic approach, with presumable low morbidity and cost-efficiency.
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Affiliation(s)
- Robert Memba
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain; Professorial Surgical Unit, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland; Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Joan XXIII University Hospital, Tarragona, Spain.
| | - Sergio González
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Daniel Coronado
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Verónica González
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Fernando Mata
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - José Antonio Rodríguez
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Carlos Mühlenberg
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Sala
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Ruth Ribas
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Eva Pueyo
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Alfredo Mata
- Gastroenterologist Endoscopy Unit, Gastroenterology Department, Sant Joan Despí-Moisès Broggi Hospital, Consorci Sanitari Integral, Barcelona, Spain
| | - Donal B O'Connor
- Professorial Surgical Unit, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Kevin C Conlon
- Professorial Surgical Unit, Trinity College Dublin, Tallaght Hospital, Dublin, Ireland
| | - Rosa Jorba
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Department, Joan XXIII University Hospital, Tarragona, Spain
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Fang L, Wang J, Dai WC, Liang B, Chen HM, Fu XW, Zheng BB, Lei J, Huang CW, Zou SB. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc 2018; 32:4742-4748. [PMID: 30298446 DOI: 10.1007/s00464-018-6195-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND LTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones. METHODS To describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed. RESULTS CBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3-8 mm, and 85 patients with cystic duct diameter ≥ 5 mm. The mean time for CBD stone extraction was 25.3 min, with the operative time ranged from 63 to 170 min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter ≥ 5 mm. Estimated blood loss during surgery was 10-120 ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3-7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months. CONCLUSIONS Based on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.
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Affiliation(s)
- L Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
| | - J Wang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - W C Dai
- Department of General Surgery, Yili Friendship Hospital, Yili, Xinjiang, China
| | - B Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - H M Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - X W Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - B B Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - J Lei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - C W Huang
- Department of Hepatobiliary Surgery, The People's Hospital of Jiangxi, Nanchang, Jiangxi, China
| | - S B Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
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Should T-Tube Drainage be Performed for Choledocholithiasis after Laparoscopic Common Bile Duct Exploration? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2018; 27:415-423. [PMID: 29023332 DOI: 10.1097/sle.0000000000000472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) has been verified to be a comparatively effective treatment approach for uncomplicated choledocholithiasis, and it has been previously proposed that the primary duct closure (PDC) technique, in which the bile duct can directly be sutured in only 1 step compared with the T-tube drainage (TTD), can be deemed a choice after LCBDE; however, the conventional TTD performance is controversial in the minimally invasive surgery era. On the basis of the above-mentioned point, this meta-analysis was conducted to assess the different effects between TTD and PDC after LCBDE. MATERIALS AND METHODS In PubMed, EMBASE, and the Cochrane Library, literature search was conducted to screen out randomized controlled trials (RCTs) to compare PDC with TTD. The analyzed outcome variables included overall morbidity, biliary-specific morbidity (retained stones, biliary leak, biliary peritonitis), other morbidities, operating time, postoperative hospital stay, reintervention (surgery, endoscopy/radiology), and median hospital expenses. RESULTS In this meta-analysis, there are 4 RCTs qualifying for inclusion, including 396 patients in all (222 in PDC and 214 in TTD). With respect to postoperative overall morbidity (P<0.05), biliary peritonitis (P<0.05), surgery time (P<0.05), length of stay (P<0.05), and median hospital expenses (P<0.05), PDC presented remarkably better results than TTD (P<0.05). Statistically, no remarkable distinction was found between the 2 groups as to biliary-specific morbidity, retained stones, biliary leak, other morbidities, or reintervention (radiology/endoscopy, surgery). CONCLUSIONS In this meta-analysis, there was no evidence provided for clinical benefits of using TTD after LCBDE. Therefore, TTD should not routinely be performed after LCBDE. However, multicenter, large sample size, RCTs should be conducted to clarify this issue.
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Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysis. Surg Endosc 2018; 32:4363-4376. [PMID: 29943056 DOI: 10.1007/s00464-018-6286-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The best approach for treating common bile duct stones remains a matter of debate. Traditional laparoscopic common bile duct exploration (LCBDE) can cause adverse events such as stenosis of the bile duct. Moreover, with advances in technology and surgical skills, the use of laparoscopic transcystic common bile duct exploration (LTCBDE) is gradually rising. OBJECTIVES To compare the safety, feasibility, and short-term clinical benefits of LTCBDE and LCBDE through matched cases. METHODS Web of science, Cochrane, PubMed, and CNKI were searched systematically to identify studies published between January 2007 and December 2017 that compared LTCBDE and LCBDE without a restriction of languages. This meta-analysis was performed using Review Manager 5.3. RESULTS Twenty-one studies matched the selection criteria, including 1561 cases of LTCBDE and 1500 cases of LCBDE. There was no obvious difference in stone clearance (OR 1.44, 95% CI 0.84-2.47; P = 0.18). However, LTCBDE had a shorter operative time (MD - 17.72, 95% CI - 19.42 to - 16.02; P < 0.00001) and shorter hospital stay (MD - 2.20, 95% CI - 2.32 to - 2.08; P < 0.00001). Besides, the LTCBDE group showed significantly better results for blood loss (MD - 7.61, 95% CI - 8.85 to - 6.37; P < 0.00001) and postoperative complications (OR 0.28, 95% CI 0.19-0.41; P < 0.00001). In addition, LTCBDE was more cost efficient (MD - 2.51, 95% CI - 2.72 to - 2.30; P < 0.00001). Further, we calculated the absolute mean of operative time (LTCBDE:LCBDE = 97.56:117.81 min), hospital stay (LTCBDE:LCBDE = 5.22:8.91 days), hospital expenses (LTCBDE:LCBDE = 8646.121:11848.31 RMB), blood loss (LTCBDE:LCBDE = 29.3:52.0 ml), the rate of CBD stone clearance (LTCBDE:LCBDE = 92.8:95.0%), and postoperative complications (LTCBDE:LCBDE = 6.7:14.6%) in both groups to obtain more convincing results. CONCLUSIONS The stone clearance of LTCBDE was equal to that of LCBDE, and LTCBDE demonstrated a shorter operative time, lower blood loss, and other advantages. Thus, the surgical procedure of laparoscopic transcystic choledochotomy is feasible and safe.
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Bove A, Di Renzo RM, Palone G, Testa D, Malerba V, Bongarzoni G. Single-stage procedure for the treatment of cholecysto-choledocolithiasis: a surgical procedures review. Ther Clin Risk Manag 2018; 14:305-312. [PMID: 29503549 PMCID: PMC5824758 DOI: 10.2147/tcrm.s146461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
While laparoscopic cholecystectomy is generally accepted as the treatment of choice for simple gallbladder stones, in cases in which common bile duct stones are also present, clinical and diagnostic elements, along with intraoperative findings, define the optimal means of treatment. All available options must be accessible to the surgical team which must necessarily be multidisciplinary and include a surgeon, an endoscopist, and a radiologist in order to identify the best option for a truly personalized surgery. This review describes the different techniques and approaches used based on distinctive recommendations and factors, according to the specific cases treated and the results achieved.
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Affiliation(s)
- Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Raffaella Maria Di Renzo
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Gino Palone
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Domenica Testa
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Valentina Malerba
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Bongarzoni
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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Laparoscopy-assisted micropercutaneous choledocholithotripsy with holmium laser in a cholecystectomized patient: an initial report. Wideochir Inne Tech Maloinwazyjne 2018; 12:443-447. [PMID: 29362661 PMCID: PMC5776494 DOI: 10.5114/wiitm.2017.72328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/22/2017] [Indexed: 11/23/2022] Open
Abstract
We present a novel minimally invasive technique, laparoscopy-assisted micropercutaneous choledocholithotripsy, for choledocholithiasis that cannot be treated with other endoscopic techniques. This technique includes standard laparoscopic exploration of the common bile duct, combined with an all-seeing needle and holmium laser lithotripsy. As is known, an all-seeing needle is used in micropercutaneous nephrolithotomy for middle-sized renal stones. In this technique, an all-seeing needle was inserted into the dilatated common bile duct under laparoscopic vision and then a lithotripsy procedure was performed with a holmium laser behind the biliary stent. A cholecystectomized female patient with a 21-mm stone in the common bile duct who previously underwent an unsuccessful endoscopic retrograde cholangiopancreatography procedure was operated on in our service with laparoscopy-assisted micropercutaneous choledocholithotomy without a T-tube. This novel procedure was completed uneventfully and the patient was discharged without any complications. In the future, this procedure will hopefully be a treatment modality in choledocholithiasis that cannot be treated by other minimally invasive techniques.
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Chuang SH, Hung MC, Huang SW, Chou DA, Wu HS. Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches. Surg Endosc 2018. [PMID: 28643057 DOI: 10.1007/s00464-017-5658-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic surgery for choledocholithiasis is still evolving. Only a few reports of single-incision laparoscopic common bile duct exploration (LCBDE) have been published. METHODS One hundred and one consecutive patients underwent single-incision LCBDE (SILCBDE) by one surgeon with straight instruments during a 42-month period. RESULTS Choledochotomies were performed on 61 patients (60.4%). The success rate of intrahepatic duct exploration was 68.0% (17/25) for patients undergoing transcystic choledochoscopic bile duct explorations following longitudinal cystic ductotomies. The ductal clearance rate was 100%. Eighteen procedures (17.8%) were converted, including one open surgery. Nineteen patients (18.8%) experienced 26 episodes of complications; the majority (19 episodes) were classified as Clavien-Dindo grade I. Excluding those patients with Mirizzi syndrome (McSherry type II), multivariate logistic regressions showed that patients who were older or had complicated cholecystitis had higher procedure conversion rates and that higher modified APACHE II scores, higher white blood cell counts, and longer operative times were independent risk factors for complications. Based on operative times, 20 successful SILCBDEs were needed to get through the learning phase. A higher transcystic approach rate (46.5 vs. 8.3%; P < 0.01) and a shorter operative time (207 ± 62 vs. 259 ± 66 min; P < 0.01) were observed in the experienced phase. Compared with our early series of multi-incision LCBDE, the SILCBDE group had a higher bile duct stone clearance rate (100 vs. 94.4%; P < 0.05) and a higher proportion of patients with concomitant acute cholecystitis (59.6 vs. 22.2%; P < 0.01). CONCLUSIONS LCBDE with a 100% ductal clearance rate is possible following an algorithm for various approaches. SILCBDE is feasible under a low threshold for procedure conversion. A transcystic approach should be tried first if indicated, and a longitudinal cystic ductotomy to the cystocholedochal junction is beneficial. Prospective, randomized trials comparing single-incision and multi-incision LCBDE are anticipated.
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Affiliation(s)
- Shu-Hung Chuang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Min-Chang Hung
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Shih-Wei Huang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Dev-Aur Chou
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan.
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan.
| | - Hurng-Sheng Wu
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
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Zerey M, Haggerty S, Richardson W, Santos B, Fanelli R, Brunt LM, Stefanidis D. Laparoscopic common bile duct exploration. Surg Endosc 2017; 32:2603-2612. [DOI: 10.1007/s00464-017-5991-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/26/2017] [Indexed: 12/16/2022]
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Otani T, Yokoyama N, Sato D, Kobayashi K, Iwaya A, Kuwabara S, Yamazaki T, Matsuzawa N, Saito H, Katayanagi N. Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy. Asian J Endosc Surg 2017; 10:282-288. [PMID: 28176466 DOI: 10.1111/ases.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the safety and efficacy of a novel continuous incision technique for the cystic duct and the bile duct over the orifice for laparoscopic transcystic choledocholithotomy (LTCL). METHODS LTCL was attempted in 103 consecutive patients from January 1998 to March 2015 and was successful in 96 patients. The cystic duct confluence was made by cutting upward from the orifice in 19 patients. The cystic duct was incised downward beyond the orifice to the bile duct in the other 77 patients. Both of these procedures involved LTCL. RESULTS LTCL was successful in 96 patients. It failed in seven patients because of large bile duct stones (BDS), left lateral entry of the cystic duct, or the cystic duct's small diameter. The success rates of LTCL were 98% (47/48), 96% (42/44), and 64% (7/11) for patients with BDS <10 mm, 10-20 mm, and ≥20 mm, respectively. The success rate for removing BDS <20 mm was significantly higher than the removal rate for BDS ≥20 mm (P < 0.0001). There was no significant difference between the incidences of complications associated with BDS ≥10 mm and with BDS <10 mm (P = 0.49). In those who underwent successful LTCL, complications occurred in 3 of 23 patients with failed preoperative duodenoscopic sphincterotomy and in 9 of the other 73 patients; the incidence of complications did not significantly differ between these groups (P = 0.93). CONCLUSION LTCL is safe and feasible for exploration of the bile duct and removal of BDS <20 mm.
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Affiliation(s)
- Tetsuya Otani
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoyuki Yokoyama
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Daisuke Sato
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Kazuaki Kobayashi
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Akira Iwaya
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Shirou Kuwabara
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | | | - Natsumi Matsuzawa
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Hideki Saito
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
| | - Norio Katayanagi
- Department of Surgery, Niigata City General Hospital, Niigata, Japan
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Quaresima S, Balla A, Guerrieri M, Campagnacci R, Lezoche E, Paganini AM. A 23 year experience with laparoscopic common bile duct exploration. HPB (Oxford) 2017; 19:29-35. [PMID: 27890483 DOI: 10.1016/j.hpb.2016.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/14/2016] [Accepted: 10/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) during laparoscopic cholecystectomy (LC) is as effective as two-stage endo-laparoscopic treatment, but with shorter hospital stay, lower cost and recurrent stone rate. Aim of this paper was to report the authors' experience with LCBDE during LC. METHODS A retrospective analysis of patients who underwent LCBDE for ductal stones was performed. Recurrent stones were defined as CBD stones detected beyond 6 months from the procedure. Postoperative biliary stricture was defined as a symptomatic reduction of CBD diameter. RESULTS Out of 3444 patients who underwent LC, 384 (11%) had CBD stones treated by trans-cystic duct exploration [214 (6%) patients, TCD-CBDE] or choledochotomy [170 (5%) patients, C-CBDE]. For TCD-CBDE and C-CBDE, mean operative time was 127 ± 69 and 191 ± 74 min, respectively. Major morbidity rate was 3% (n = 6) in TCD-CBDE and 6% (n = 11) in C-CBDE. The incidence of residual stones was 5% (n = 20) and complete ductal clearance rate was 95% (n = 364). After long-term follow-up (mean 189 ± 105 months) the recurrent stone rate was 2%. DISCUSSION In expert centers, LCBDE during LC is safe and effective with low short and long term morbidity rates.
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Affiliation(s)
- Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
| | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121 Ancona, Italy
| | - Roberto Campagnacci
- Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121 Ancona, Italy
| | - Emanuele Lezoche
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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Zheng C, Huang Y, Xie E, Xie D, Peng Y, Wang X. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surg Endosc 2016; 31:2541-2547. [PMID: 28008469 DOI: 10.1007/s00464-016-5257-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Common bile duct (CBD) stone is one of the most common diseases among elderly people. In recent decades, there are numerous studies regarding the safety and efficacy of laparoscopic common bile duct exploration (LCBDE). Elderly patients are often regarded as high-risk patients because they are more likely to present with age-specific deterioration of organ function and coexisting chronic diseases, which may reduce their tolerance of laparoscopic surgery. Although laparoscopic surgery for choledocholithiasis is now widely accepted as the treatment for CBD stone, its appropriateness for the treatment of elderly patients or those with coexisting high-risk patients has not been well established. Therefore, the objective of this paper is to analyze the safety and efficacy of LCBDE in elderly patients. METHODS Between January 2012 and November 2015, 376 patients underwent LCBDE in our center. Based on their ages, they were divided into two groups, and a retrospective study was performed. By making comparisons between younger group who were younger than 70 years (n = 253) and elderly group who were 70 years old or older (n = 123), the demographics, clinical characteristics, laboratory data, operative parameters and outcomes were analyzed. RESULTS Before operation, elderly patients had more coexisting chronic diseases and risk factors, such as arterial hypertension, heart diseases, pulmonary diseases and previous abdominal surgery (P < 0.05). In both groups, LCBDE was equally successful with a high clearance rate (100 % in elderly patients vs. 98.8 % in younger group, P = 0.554). Besides, the operating time, intraoperative blood loss, postoperative hospital stay, total costs and overall complication showed no significant difference between two groups (P > 0.05). There was no major bile duct injury or death in either group. CONCLUSION Although elderly patients are frequently confronted with coexisting disorders, LCBDE can be considered as a safe and effective technique in choledocholithiasis treatment for elderly patients.
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Affiliation(s)
- Chufa Zheng
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Yaokui Huang
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - E Xie
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Dejin Xie
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Yunheng Peng
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Xiaozhong Wang
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China.
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Tokumura H, Iida A, Sasaki A, Nakamura Y, Yasuda I. Gastroenterological surgery: The gallbladder and common bile duct. Asian J Endosc Surg 2016; 9:237-249. [PMID: 27790872 DOI: 10.1111/ases.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hiromi Tokumura
- Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan.
| | - Atsushi Iida
- First Department of Surgery, University of Fukui, Fukui, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Feng Q, Huang Y, Wang K, Yuan R, Xiong X, Wu L. Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy. PLoS One 2016; 11:e0162885. [PMID: 27668730 PMCID: PMC5036868 DOI: 10.1371/journal.pone.0162885] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022] Open
Abstract
Purpose The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy) for removal of common bile duct stones. Methods A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR) or the mean difference (MD) with 95% confidence interval (CI) for this study. Results The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE) (n = 1,222) and laparoscopic transcystic common bile duct exploration (LTCBDE) (n = 1,560) regarding stone clearance (OR 0.73, 95% CI 0.50–1.07; P = 0.11), conversion to other procedures (OR 0.62, 95% CI 0.21–1.79; P = 0.38), total morbidity (OR 1.65, 95% CI 0.92–2.96; P = 0.09), operative time (MD 12.34, 95% CI −0.10–24.78; P = 0.05), and blood loss (MD 1.95, 95% CI −9.56–13.46; P = 0.74). However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30–7.85; P<0.001), hospital stay (MD 2.52, 95% CI 1.29–3.75; P<0.001), and hospital expenses (MD 0.30, 95% CI 0.23–0.37; P<0.001) than the LCCBDE group. Conclusions LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.
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Affiliation(s)
- Qian Feng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yong Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Kai Wang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Rongfa Yuan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xiaoli Xiong
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Linquan Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- * E-mail:
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Gui L, Liu Y, Qin J, Zheng L, Huang YJ, He Y, Deng WS, Qian BB, Luo M. Laparoscopic Common Bile Duct Exploration Versus Open Approach in Cirrhotic Patients with Choledocholithiasis: A Retrospective Study. J Laparoendosc Adv Surg Tech A 2016; 26:972-977. [PMID: 27509535 DOI: 10.1089/lap.2016.0308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the safety and benefits of laparoscopic common bile duct exploration (LCBDE) compared with open approach (OCBDE) in cirrhotic patients. MATERIALS AND METHODS Between January 2009 and December 2012, a total of 113 cirrhotic patients with choledocholithiasis underwent common bile duct (CBD) explorations in our department. There were two groups of patients: A:LCBDE (n = 61) and B:OCBDE (n = 52). Patients' demographic characteristics, surgical data, postoperative outcomes, and long-term results were retrospectively collected and analyzed. RESULTS There were no significant differences between the two groups in the demographic characteristics or preoperative status. The transcystic approach was successfully performed in 52 (46.0%) patients (group A:34, group B:20), whereas choledochotomy was successful in 59 (54.0%) patients (group A:27, group B:32). The differences between group A and group B in terms of surgical time (124.9 ± 34.2 minutes versus 132.6 ± 48.6 minutes, P = .323), stone clearance rate (93.4% versus 94.2%, P > .05), short-term complication rate (9.8% versus 13.4%, P = .547), and recurrent stone rate (6.6% versus 5.8%, P > .05) were not statistically significant. However, group A suffered less blood loss [95 (60-200) mL versus 200 (90-450) mL, P < .001] and shorter length of hospital stay (4.7 ± 2.5 days versus 11.3 ± 3.1 days, P < .001) than group B. In the LCBDE group, 4 (6.6%) patients were converted due to heavy inflammation and severe adhesions. No mortality, biliary injury, or stricture occurred during follow-up. CONCLUSION LCBDE can be safely performed in patients with Child-Pugh A or B cirrhosis and choledocholithiasis, with considerable efficiency, minimal short-term complications, and acceptable long-term outcomes. LCBDE has the advantages over open CBD exploration of less bleeding and reduced length of hospital stay.
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Affiliation(s)
- Liang Gui
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Ye Liu
- 2 Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jun Qin
- 2 Department of General Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Lei Zheng
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yi-Jun Huang
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Yue He
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Wen-Sheng Deng
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Bin-Bin Qian
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Meng Luo
- 1 Department of General Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
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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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Abstract
Background and Objectives: To investigate the possibility of extracting common bile duct (CBD) stones by laparoscopically inserting choledochoscope through the natural orifice of the cystic duct and a mini-incision on the CBD, and the safety of laparoscopic primary double-layer suture of the cystic duct and CBD. Methods: Laparoscopic transcystic choledochotomy and extraction of stones with primary suture was performed on 194 patients with gallbladder and CBD stones from October 1, 2009, through April 30, 2012. The cystic duct was left at a diameter of 1 to 1.5 cm after removal of the gallbladder. The duct was longitudinally cut at its ventral side to the confluence with the CBD, and the anterior wall of the CBD was also cut longitudinally. A choledochoscope was then inserted via the enlarged opening, and the stones were extracted from the CBD. Finally, the CBD and cystic duct were closed by continuous mucous layer suture and seromuscular Lembert suture, respectively. The cystic duct was ligated close to the CBD and an abdominal drainage tube was placed. Results: All surgical procedures were successfully performed. The caliber at the confluence between the cystic duct and the CBD was 0.3 to 0.8 cm (SD 0.4 ± 0.1 cm), and the mini-incision of the CBD was 0.1 to 1.1 cm (SD 0.3 ± 0.2 cm). Abdominal drainage lasted 3 to 5 days. Magnetic resonance cholangiopancreatography (MRCP) in 55 patients showed no abnormal change in the CBD diameter. Two patients had bile leakage. Another patient had intermittent abdominal pain and jaundice 5 to 7 days postoperatively, and the retained stones spontaneously passed. The postoperative hospital stay was 6 to 13 days (SD 8 ± 2.1 days). Observation of 176 patients (90%) lasting 1 to 30 months (SD 11 ± 8 months) showed no recurrent stones or stricture of the CBD. Conclusion: The surgical procedure of laparoscopic transcystic choledochotomy and extraction of stones with primary suture is feasible and safe.
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Affiliation(s)
- Dexing Chen
- Qianwei Hospital of Jilin Province, Changchun, China
| | - Andong Zhu
- Qianwei Hospital of Jilin Province, Changchun, China
| | - Zhibo Zhang
- Peking Union Medical College Hospital, Beijing, China
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Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutan Tech 2016; 25:218-22. [PMID: 25799258 DOI: 10.1097/sle.0000000000000133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the difference of primary suture following 3-port laparoscopic common bile duct exploration (LCBDE) between modified transcystic and transcholedochal approach in the treatment of choledocholithiasis. MATERIALS AND METHODS Patients who underwent 3-port LCBDE by modified transcystic approach (n = 80) and those who underwent 3-port LCBDE by transcholedochal approach (n = 209) were included in this study. The operative time, duration of hospital stay, diameter of the cystic duct, diameter of the common bile duct (CBD), complications, and demographics were retrospectively analyzed in all patients. RESULTS All operations were successfully performed. No patient was converted to laparotomy. No mortality was associated with the 2 groups. There was no significant difference between the 2 groups for the operative time (91.94 ± 34.21 min vs. 96.13 ± 32.15 min), duration of hospital stay (9.82 ± 3.48 d vs. 10.74 ± 5.34 d), diameter of cystic duct (0.47 ± 0.09 cm vs. 0.47 ± 0.08 cm), and complications (2.5% vs. 2.87%) (all P > 0.05). A significant difference was observed in terms of the diameter of CBD (1.18 ± 0.29 cm vs. 1.04 ± 0.24 cm P < 0.05). CONCLUSIONS The modified transcystic LCBDE was safe and feasible for treating choledocholithiasis but it might be more suitable for the CBD with a smaller diameter.
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Zhu JG, Han W, Guo W, Su W, Bai ZG, Zhang ZT. Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis. Br J Surg 2015; 102:1691-7. [PMID: 26395452 DOI: 10.1002/bjs.9922] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/17/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The best approach for cholecystocholedocholithiasis remains a matter of debate. The aim of this study was to evaluate the technical aspects, learning curve and outcome of laparoscopic transcystic common bile duct exploration (LTCBDE). METHODS Patients who underwent laparoscopic cholecystectomy with LTCBDE between January 2007 and December 2012 were identified from an institutional database. Data on preoperative investigations, intraoperative and postoperative findings were retrieved retrospectively from the patients' hospital notes. RESULTS There were 399 women (56·4 per cent) and 309 men (43·6 per cent), with a median age of 58 (range 18-87) years. Microincision (incision of the cystic duct at the confluence with the common bile duct (CBD) with extension of only 3-5 mm at the lateral margin of the CBD) and lithotripsy were used in the transcystic exploration in 119 patients, and increased the success rate of LTCBDE from 74·2 to 91·0 per cent. The median duration of operation was 85 (i.q.r. 65-120) min and the median postoperative hospital stay was 2 (1-3) days. Retained common bile duct stones were observed in 13 patients, and postoperative complications developed in 27 patients. The cumulative sum duration of operation learning curve comprised two phases; phase 1 included the first 250 patients and phase 2 the remaining 458 patients. Duration of operation and postoperative hospital stay decreased with increasing volume per surgeon. Recurrence of common bile duct stones was diagnosed in 26 patients during a median follow-up of 4 years. CONCLUSION LTCBDE with or without microincision and/or lithotripsy is a safe and effective approach.
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Affiliation(s)
- J G Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing, China
| | - W Han
- Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - W Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing, China
| | - W Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Z G Bai
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing, China
| | - Z T Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing, China
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Podda M, Polignano FM, Luhmann A, Wilson MSJ, Kulli C, Tait IS. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 2015; 30:845-61. [PMID: 26092024 DOI: 10.1007/s00464-015-4303-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis. METHODS A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications. RESULTS Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95% CI 0.06-0.76, P = 0.02), operating time (WMD, -22.27, 95% CI -33.26 to -11.28, P < 0.00001), postoperative hospital stay (WMD, -3.22; 95% CI -4.52 to -1.92, P < 0.00001), and median hospital expenses (SMD, -1.37, 95% CI -1.96 to -0.77, P < 0.00001). Postoperative hospital stay was significantly decreased in the primary duct closure with internal biliary drainage (PDC + BD) group when compared to TTD group (WMD, -2.68; 95% CI -3.23 to -2.13, P < 0.00001). CONCLUSIONS This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered as the optimal procedure for dochotomy closure after LCBDE.
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Affiliation(s)
- Mauro Podda
- HPB and UpperGI Surgery Unit, Ninewells Hospital and Medical School, Ward 11, Dundee, DD1 9SY, UK.
| | | | - Andreas Luhmann
- HPB and UpperGI Surgery Unit, Ninewells Hospital and Medical School, Ward 11, Dundee, DD1 9SY, UK.
| | | | - Christoph Kulli
- HPB and UpperGI Surgery Unit, Ninewells Hospital and Medical School, Ward 11, Dundee, DD1 9SY, UK.
| | - Iain Stephen Tait
- HPB and UpperGI Surgery Unit, Ninewells Hospital and Medical School, Ward 11, Dundee, DD1 9SY, UK.
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Abstract
Common bile duct exploration (CBDE) is an accepted treatment for choledocholithiasis. This procedure is not well studied in the elderly population. Here we evaluate the results of CBDE in elderly patients (>70 years) and compare the open (group A) with the laparoscopic group (group B). A retrospective review was performed of elderly patients with proven common bile duct (CBD) stones who underwent CBDE from January 2005 to December 2009. There were 55 patients in group A and 33 patients in group B. Mean age was 77.6 years (70-91 years). Both groups had similar demographics, liver function tests, and stone size-12 mm (range, 5-28 mm). Patients who had empyema (n = 9), acute cholecystitis (n = 15), and those who had had emergency surgery (n = 28) were more likely to be in group A (P < 0.05). The mean length of stay for group A was 11.7 ± 7.3 days; for group B, 5.2 ± 6.3 days; the complication rate was higher in group A (group A, 38.2%; group B, 8.5%; P = 0.072). The overall complication and mortality rate was 29.5% and 3.4%, respectively. CBDE can be performed safely in the elderly with accepted morbidity and mortality. The laparoscopic approach is feasible and safe in elective setting even in the elderly.
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Affiliation(s)
- Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - JeeKeem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Zhang WJ, Xu GF, Huang Q, Luo KL, Dong ZT, Li JM, Wu GZ, Guan WX. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg 2015; 15:7. [PMID: 25623774 PMCID: PMC4417333 DOI: 10.1186/1471-2482-15-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/15/2015] [Indexed: 01/17/2023] Open
Abstract
Background Laparoscopic common bile duct exploration (LCBDE) for stone can be carried out by either laparoscopic transcystic stone extraction (LTSE) or laparoscopic choledochotomy (LC). It remains unknown as to which approach is optimal for management of gallbladder stone with common bile duct stones (CBDS) in Chinese patients. Methods From May 2000 to February 2009, we prospective treated 346 consecutive patients with gallbladder stones and CBDS with laparoscopic cholecystectomy and LCBDE. Intraoperative findings, postoperative complications, postoperative hospital stay and costs were analyzed. Results Because of LCBDE failure,16 cases (4.6%) required open surgery. Of 330 successful LCBDE-treated patients, 237 underwent LTSE and 93 required LC. No mortality occurred in either group. The bile duct stone clearance rate was similar in both groups. Patients in the LTSE group were significantly younger and had fewer complications with smaller, fewer stones, shorter operative time and postoperative hospital stays, and lower costs, compared to those in the LC group. Compared with patients with T-tube insertion, patients in the LC group with primary closure had shorter operative time, shorter postoperative hospital stay, and lower costs. Conclusions In cases requiring LCBDE, LTSE should be the first choice, whereas LC may be restricted to large, multiple stones. LC with primary closure without external drainage of the CBDS is as effective and safe as the T-tube insertion approach.
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Affiliation(s)
- Wei-jie Zhang
- Department of General Surgery, the Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. .,Department of General Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
| | - Gui-fang Xu
- Department of Gastroenterology, Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Qin Huang
- Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, Boston, Massachusetts, 02132, USA.
| | - Kun-lun Luo
- Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China.
| | - Zhi-tao Dong
- Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China.
| | - Jie-ming Li
- Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China.
| | - Guo-zhong Wu
- Department of General Surgery, 101st Hospital of PLA, Wuxi, Jiangsu, 214044, China.
| | - Wen-xian Guan
- Department of General Surgery, the Affiliated Drum tower Hospital of Nanjing University Medical School, Nanjing, 210008, China. .,Department of General Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.
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Zhu JG, Zhang ZT. Laparoscopic Remnant Cholecystectomy and Transcystic Common Bile Duct Exploration for Gallbladder/Cystic Duct Remnant with Stones and Choledocholithiasis After Cholecystectomy. J Laparoendosc Adv Surg Tech A 2015; 25:7-11. [PMID: 25535723 DOI: 10.1089/lap.2014.0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jie-gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhong-tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Abstract
AIM : This study aimed to evaluate single-stage surgical (laparoscopic or open) approach to the management of common bile duct (CBD) stones, as treatment of choice. METHODS Prospectively collected data to assess outcomes of CBD clearance, morbidity, mortality, and hospital stay, and compared with published data. RESULTS Successful clearance of CBD stones was achieved in 96% cases, laparoscopic exploration successful in 83%. Retained stones were found in 4% cases and another 5% developed postoperative complications. Common length of stay in hospital was 2 days, although mean stay was 4 days. Seventy-three percent of cases were elective, 27% were emergencies. Conversion rate to open surgery was 14%, which was mainly in emergency cases. Postoperative mortality was 1.2%, not directly related to the procedure. CONCLUSIONS Good outcomes can be achieved, comparing favorably with those of other modalities, when laparoscopic bile duct exploration is chosen as treatment for CBD stones; the best results can be anticipated in elective patients.
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Li P, Zhang Z, Li J, Jin L, Han W, Zhang J. Diagnostic value of magnetic resonance cholangiopancreatography for secondary common bile duct stones compared with laparoscopic trans-cystic common bile duct exploration. Med Sci Monit 2014; 20:920-6. [PMID: 24894946 PMCID: PMC4061148 DOI: 10.12659/msm.890831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study was to evaluate the diagnostic potential of magnetic resonance cholangiopancreatography (MRCP) in preoperative patients with secondary common bile duct stones during the application of laparoscopic trans-cystic common bile duct exploration (LTCBDE). Material/Methods The clinical records of 255 patients were retrospectively analyzed. All patients included in the study were examined by MRCP 3 days prior to LTCBDE. Results Secondary bile duct stones were detected in 220 patients using LTCBDE. Of the patients diagnosed by MRCP, 141 were true-positive, 28 were true-negative, 7 were false-positive and 79 were false-negative. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRCP for secondary common bile duct stones were 64.09%, 80.00%, 66.27%, 95.27%, and 26.17%, respectively. When the cases with muddy stones were excluded, the outcomes were 80.41%, 79.41%, 69.23%, 94.44%, and 48.21%, respectively. When cases with stones <3 mm (inclusive) in diameter were excluded, the outcomes were 93.75%, 79.41%, 86.27%, 93.75%, and 65.85%, respectively. When cases with stones <5 mm (inclusive) in diameter were excluded, the outcomes were 93.10%, 79.41%, 89.26%, 92.05%, and 81.82%, respectively. Conclusions The effectiveness of preoperative MRCP is overestimated for the diagnosis of secondary common bile duct stones, particularly for muddy and micro-stones.
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Affiliation(s)
- Peixin Li
- Department of Comprehensive Surgery, Medical and Health Center, Beijing Friendship Hospital affiliated to Capital Medical University, Beijing, China (mainland)
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical Universit, Beijing, China (mainland)
| | - Jianshe Li
- Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical Universit, Beijing, China (mainland)
| | - Lan Jin
- Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical Universit, Beijing, China (mainland)
| | - Wei Han
- Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical Universit, Beijing, China (mainland)
| | - Jie Zhang
- Department of Medical Imaging, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China (mainland)
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Naumowicz E, Białecki J, Kołomecki K. Results of treatment of patients with gallstone disease and ductal calculi by single-stage laparoscopic cholecystectomy and bile duct exploration. Wideochir Inne Tech Maloinwazyjne 2014; 9:179-89. [PMID: 25097684 PMCID: PMC4105674 DOI: 10.5114/wiitm.2014.41629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/14/2013] [Accepted: 10/20/2013] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Choledocholithiasis is the most common cause of obstructive jaundice. Common bile duct stones are observed in 10-14% of patients diagnosed with gall bladder stones. In the case of gall bladder and common bile duct stones the procedure involves not only performing cholecystectomy but also removing the stones from bile ducts. AIM To compare the results of the treatment of patients with gallstone disease and ductal calculi by one-stage laparoscopic cholecystectomy and common bile duct exploration with two other methods: one-stage open cholecystectomy and common bile duct exploration, and a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. MATERIAL AND METHODS Between 2004 and 2011 three groups of 100 patients were treated for obstructive jaundice caused by choledocholithiasis. The first group of 42 patients underwent ERCP followed by laparoscopic cholecystectomy. The second group of 23 patients underwent open cholecystectomy and common bile duct exploration, whereas the third group of 35 patients underwent laparoscopic cholecystectomy with common bile duct exploration. The data were analysed prospectively. The methods were compared according to complete execution, bile duct clearance and complication rate. Complications were analysed according to Clavien's Classification of Surgical Complications. The results were compared using the ANOVA statistical test and Student's t-test in Statistica. Value of p was calculated statistically. A p-value less than 0.05 (p < 0.05) signified that groups differed statistically, whereas a p-value more than 0.05 (p > 0.05) suggested no statistically significant differences between the groups. RESULTS The procedure could not be performed in 11.9% of patients in the first group and in 14.3% of patients in the third group. Residual stones were found in 13.5% of the patients in the first group, in 4.3% of the patients in the second group and in 6.7% of the patients in the third group. According to Clavien's classification of complications grade II and III, we can assign the range in the first group at 21.6% for grade II and 0% for grade III, in the second group at 21.4% and 3.6% and in the third group at 6.7% and 3.3% respectively. CONCLUSIONS The use of all three methods of treatment gives similar results. One-stage laparoscopic cholecystectomy with common bile duct exploration is after all the least invasive, safer and more effective procedure.
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Affiliation(s)
- Eryk Naumowicz
- Department of General Surgery, HCP Medical Centre, Poznan, Poland
| | - Jacek Białecki
- Department of General Surgery, HCP Medical Centre, Poznan, Poland
| | - Krzysztof Kołomecki
- Department of Endocrine, General and Vascular Surgery, Medical University of Lodz, Lodz, Poland
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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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Chuang SH, Chen PH, Chang CM, Tsai YF, Lin CS. Single-incision laparoscopic common bile duct exploration with conventional instruments: an innovative technique and a comparative study. J Gastrointest Surg 2014; 18:737-43. [PMID: 24347312 DOI: 10.1007/s11605-013-2420-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/15/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed. METHODS Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed. RESULTS The stone clearance rate was 94.1% (16 patients) in the standard LCBDE group and 100% in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3%; p < 0.05). One procedure (5.9%) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8% (two patients) in the standard LCBDE group and 5.9% (one patient) in the SILCBDE group. The average follow-up period was 4.2 months. CONCLUSION SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.
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Affiliation(s)
- Shu-Hung Chuang
- Department of Biological Science and Technology, National Chiao Tung University, No.75 Po-Ai Street, Hsin-Chu, 30068, Taiwan
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Cuendis-Velázquez A, Rojano-Rodríguez ME, Morales-Chávez CE, González Angulo-Rocha A, Fernández-Castro E, Aguirre-Olmedo I, Torres-Ruiz MF, Orellana-Parra JC, Cárdenas-Lailson LE. [Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:22-7. [PMID: 24629570 DOI: 10.1016/j.rgmx.2013.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/13/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. OBJECTIVES To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. PATIENTS AND METHODS A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. RESULTS The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). CONCLUSIONS Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones.
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Affiliation(s)
- A Cuendis-Velázquez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
| | - M E Rojano-Rodríguez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - C E Morales-Chávez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - A González Angulo-Rocha
- Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México
| | - E Fernández-Castro
- Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México
| | - I Aguirre-Olmedo
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - M F Torres-Ruiz
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - J C Orellana-Parra
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - L E Cárdenas-Lailson
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
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Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen XM, Zhang Y, Cai HH, Sun DL, Liu SY, Duan YF, Yang C, Jiang Y, Wu HR. Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 2013; 23:977-81. [PMID: 24138388 DOI: 10.1089/lap.2013.0309] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laparoscopic transcystic common bile duct exploration has become a safe and ideal treatment of common bile duct stones. This study was designed to explore the clinical value of modified laparoscopic transcystic common bile duct exploration as a first line of treatment for patients with common bile duct stones. PATIENTS AND METHODS A retrospective, case-control study of clinically comparable groups of patients who underwent the laparoscopic transcystic approach with micro-incision of the cystic duct and its confluence part in common bile duct exploration (LTM-CBD) (n=110) and laparoscopic common bile duct exploration (LCBD) (n=100) under the care of one surgeon was performed. All clinical data were analyzed retrospectively. RESULTS There was no significant difference in terms of operation time between the two groups (P>.05). Postoperative hospital stay and abdominal drainage time were shorter in the LTM-CBD group than in the LCBD group (P<.05). Postoperative bile leakage was seen in 1 case (1 of 110) in the LTM-CBD group and 10 cases (10 of 100) in the LCBD group (P<.05). Twenty patients underwent T-tube drainage in the LCBD group, and primary closure was performed in the other patients; however, all cases in the LTM-CBD group underwent primary closure. The median follow-up was 12 months; 2 patients in the LCBD group who suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. CONCLUSIONS LTM-CBD, which can avoid postoperative T-tube drainage, decrease complications, shorten hospitalization time, and enhance the existing quality, is a minimally invasive, safe, and effective treatment.
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Affiliation(s)
- Xue-Min Chen
- 1 Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University , Changzhou, China
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Epelboym I, Winner M, Allendorf JD. MRCP is not a cost-effective strategy in the management of silent common bile duct stones. J Gastrointest Surg 2013; 17:863-71. [PMID: 23515912 DOI: 10.1007/s11605-013-2179-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 03/01/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few formal cost-effectiveness analyses simultaneously evaluate radiographic, endoscopic, and surgical approaches to the management of choledocholithiasis. STUDY DESIGN Using the decision analytic software TreeAge, we modeled the initial clinical management of a patient presenting with symptomatic cholelithiasis without overt signs of choledocholithiasis. In this base case, we assumed a 10 % probability of concurrent asymptomatic choledocholithiasis. Our model evaluated four diagnostic/therapeutic strategies: universal magnetic resonance cholangiopancreatography (MRCP), universal endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic cholecystectomy (LC), or laparoscopic cholecystectomy with universal intraoperative cholangiogram (LCIOC). All probabilities were estimated from a review of published literature. Procedure and intervention costs were equated with Medicare reimbursements. Costs of hospitalizations were derived from median hospitalization reimbursement for New York State using diagnosis-related groups (DRG). Sensitivity analyses were performed on all cost and probability variables. RESULTS The most cost-effective strategy in the diagnosis and management of symptomatic cholelithiasis with a 10 % risk of asymptomatic choledocholithiasis was LCIOC. This was followed by LC alone, MRCP, and ERCP. LC was preferred only when the probability that a retained CBD stone would eventually become symptomatic fell below 15 % or if the probability of technical success of an intraoperative cholangiogram (IOC) was less than 35 %. Universal MRCP and ERCP were both more costly and less effective than surgical strategies, even at a high probability of asymptomatic choledocholithiasis. Within the tested range for both procedural and hospitalization-related costs for any of the surgical or endoscopic interventions, LCIOC and LC were always more cost-effective than universal MRCP or ERCP, irrespective of the presence or absence of complications. Varying the cost, sensitivity, and specificity of MRCP had no effect on this outcome. CONCLUSIONS LC with routine IOC is the preferred strategy in a cost-effectiveness analysis of the management of symptomatic cholelithiasis with asymptomatic choledocholithiasis. MRCP was both more costly and less effective under all tested scenarios.
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Affiliation(s)
- Irene Epelboym
- Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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