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Nassar AHM, Qandeel H, Khan KS, Ng HJ, Hasanat S, Ashour H. The "Basket-in-Catheter" technique: facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones. Updates Surg 2023; 75:1893-1902. [PMID: 37537316 DOI: 10.1007/s13304-023-01610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
The 'Basket-in-Catheter' (BIC) technique facilitates basket-only laparoscopic transcystic exploration (LTCE), increasing its success rate. Using the cholangiography catheter as a sheath is easier and safer than inserting the wire basket-alone. This study evaluates its benefits in confirmed and suspected ductal stones. Retrospective analysis of prospectively collected data on patients with pre-operative or operative suspicion of bile duct stones or with positive and equivocal intraoperative cholangiographies (IOC) who had LTCE attempted using blind basket trawling, without choledochoscopy, were reviewed. The incidence and outcomes of blind basket LTCEs attempted before and after introducing the BIC technique, whether or not stones were retrieved, were analysed. Blind basket LTCE was attempted in 732 patients. Of 377 (51.5%) patients undergoing successful stone retrieval, only 62% had pre-operative clinical and radiological risk factors for ductal stones, 25% had operative risk factors and 13% had silent stones discovered on IOC. Another 355 patients (48.5%) had negative trawling, although one half had pre-operative risk factors for ductal stones and 47.6% had operative risk factors, e.g. cystic duct stones or dilatation. This cohort had equivocal cholangiography in 25.9%. Following basket trawling, repeat IOC confirmed resolution of abnormalities. As no stones were retrieved, these were not considered duct explorations. The BIC technique facilitates safe and speedy bile duct clearance when stones are confirmed, avoiding choledochotomies, without significant complications. BIC duct trawling is also beneficial in patients with suspected ductal stones, helping to resolve equivocal IOCs. It helps surgeons to acquire and consolidate ductal exploration skills.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK.
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland.
| | - Haitham Qandeel
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
| | - Khurram S Khan
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland
- University Hospital Hairmyres, Lanarkshire, Scotland, UK
| | - Hwei J Ng
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- Royal Alexandra Hospital, Paisley, Scotland, UK
| | - Subreen Hasanat
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
| | - Haneen Ashour
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
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Nassar A, Qandeel H, Khan K, Nj H, Hasanat S, Ashour H. Moy.03Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones. Br J Surg 2021. [DOI: 10.1093/bjs/znab310.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones.
Methods
Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.
Results
741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.
Conclusions
The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
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Nassar A, Qandeel H, Khan K, Ng H, Hasanat S, Ashour H. 1282 Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones.
Method
Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.
Results
741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.
Conclusions
The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
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Affiliation(s)
- A Nassar
- University Hospital Monklands, Airdrie, United Kingdom
| | | | - K Khan
- Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - H Ng
- Royal Alexandra Hospital, Paisley, United Kingdom
| | | | - H Ashour
- Hashemite University, Zarqa, Jordan
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Qandeel H, Tayyem R, Fataftah J, Qasem M, Sami R, Ashour H, Hasanat S, Tayyem R, Alqassieh R. Correlation Between COVID-19 Severity, Body Mass Index and Radiological Hepatic Morphology. INT J MORPHOL 2021. [DOI: 10.4067/s0717-95022021000401096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Breton J, Tirelle P, Hasanat S, Pernot A, L’Huillier C, do Rego JC, Déchelotte P, Coëffier M, Bindels L, Ribet D. Altérations du microbiote intestinal dans un modèle murin d’Anorexie mentale. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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