scholarly journals Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis: six years’ experience of a single institution

2021 ◽  
Author(s):  
Tong Guo ◽  
Lu Wang ◽  
Peng Xie ◽  
Zhiwei Zhang ◽  
Xiaorui Huang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Intrahepatic Bile Duct ◽  
Common Bile Duct Exploration ◽  
T Tube ◽  
Extubation Time ◽  
Surgical Methods ◽  
Clinical Records

Abstract Introduction The optimal treatment of choledocholithiasis combined with cholecystolithiasis remains controversial. Common surgical methods vary among endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC), laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic transductal common bile duct exploration (LCBDE) with or without T-tube drainage. The purpose of this study is to evaluate the safety and effectiveness of surgical methods and to determine the appropriate procedure for patients with cholecystolithiasis combined with choledocholithiasis. Methods From January 2013 to January 2019, a total of 1555 consecutive patients diagnosed with cholecystolithiasis combined with choledocholithiasis who underwent surgical treatment in Tongji Hospital were retrospectively analyzed. Total 521 patients with intrahepatic bile duct stones underwent LC + LCBDE + T-Tube were excluded from the analysis. At last, 1034 patients who met the inclusion criteria were divided into three groups according to their surgical methods: preoperative ERCP + subsequent LC (ERCP + LC group, n = 275), LC + LCBDE + intraoperative endoscopic nasobiliary drainage (ENBD) + primary duct closure (Tri-scope group, n = 479) and LC + laparoscopic transcystic CBD exploration (LTCBDE group, n = 280). Clinical records, operative findings and postoperative follow-up were collected and analyzed. Results There was no mortality in three groups. Common bile duct (CBD) stone clearance rate was 97.5% in ERCP + LC group, 98.7% in Tri-scope group, and 99.3% in LTCBDE group. There were no difference in terms of demographic characteristics, biochemistry findings and presentations, but the Tri-scope group had the biggest diameter and amount of stones and diameter of CBD, the LTCBDE group had the least CBD stones and the biggest diameter of cystic gall duct (CGD). ERCP + LC group have the longest hospital stay (14.16 ± 3.88 days vs 6.92 ± 1.71 days vs 10.74 ± 5.30 days, P < 0.05), also has the longest operative time than others (126.08 ± 42.79 min vs 92.31 ± 10.26 min, 99.09 ± 8.46 min, P < 0.05). Compared to ERCP + LC group, LTCBDE group and Tri-scope group had lower postoperation-leukocyte, shorter surgery duration and hospital stay (P < 0.05). Compared to the Tri-scope group, the LTCBDE group had the shorter hospital stay, extubation time and operation time and less intraoperative bleeding. There were less postoperative complications in LTCBDE group (1.1%) compared to the ERCP + LC group (3.6%) and Tri-scope group (2.2%). Follow-up time was 6 to 72 months. Four patients in ERCP + LC group and 5 in Tri-scope group reported recurrent stones. Conclusion All the three surgical methods are safe and effective. Tri-scope approach and LTCBDE approach have superiority to preoperative ERCP + LC. LC + LTCBDE shows priority over Tri-scope approach, but should be performed in selected patients. LC + LCBDE + T-Tube can be an alternative management if the other three procedures were failed. The surgeons should choose the most appropriate surgical procedure according to the preoperative examination results and intraoperative situation.

Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

2014 ◽  
Vol 80 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Chang-Hao Wu ◽  
Wen-Da Li
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Primary Closure ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

2015 ◽  
Vol 32 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Jie Hua ◽  
Shengping Lin ◽  
Daohai Qian ◽  
Zhigang He ◽  
Ti Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Bile Leak ◽  
Significant Risk ◽  
Biliary Tree ◽  
Common Bile Duct Exploration ◽  
T Tube ◽  
Duct Stricture

Background: Choledocholithiasis is traditionally managed by endoscopic retrograde cholangiopancreatography or T-tube insertion following common bile duct exploration. This study examined the efficacy and safety of primary duct closure following laparoscopic common bile duct exploration (LCBDE) via choledochotomy. Methods: Between September 2011 and September 2013, 157 consecutive patients underwent LCBDE via choledochotomy. Results: Of 157 LCBDE procedures, 138 (87.9%) were successfully completed with primary closure of the choledochotomy. Eight patients (5.1%) underwent closure with T-tube drainage after choledochotomy and 11 patients (7.0%) were converted to open surgery. The biliary tree was free of stones at the end of surgery in 154 patients (98.1%). Postoperative bile leak occurred in 6 patients (3.8%). The median follow-up period was 18 (2-33) months, with no evidence of further bile duct stones or bile duct stricture in any patients. Univariable analysis revealed that successful duct clearance (p = 0.010) and diameter of the common bile duct (p < 0.001) were two significant risk factors for bile leak. Conclusions: Primary duct closure following LCBDE is effective and safe for the management of choledocholithiasis. The postoperative bile leak rate may be low in skilled laparoscopic surgeons with a careful selection of patients.

scholarly journals Three Cases of Difficult Bile Duct Stone Removal by EUS-guided Choledochoduodenostomy

2020 ◽  
Vol 25 (2) ◽  
pp. 128-134
Author(s):  
Yeong Joo Jeong ◽  
Man Ki Choi ◽  
Seung Goun Hong
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Bile Duct Stone ◽  
Intrahepatic Bile Duct ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Metal Stent ◽  
Endoscopic Retrograde ◽  
Duration Of Hospital Stay

After failed removal of common bile duct or intrahepatic bile duct (IHD) stones by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous lithotripsy is well-known as an effective procedure. However, it is time-consuming because multiple sessions of transhepatic tract dilatation are required. Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) has been recently used to approach IHD to remove difficult bile duct stones. We recently experienced EUS-guided CDS performed with metal stent. Common bile duct or IHD stones were removed by retrieval accessories after initial failed or inadequate ERCP in three patients. Serious complications including bleeding, infection, and perforation were not noted. The duration of hospital stay from EUS-guided procedure to discharge ranged from 10 to 14 days. Although this result is interim and ongoing, it suggests that EUS-guided CDS might be an effective and safe procedure after failed ERCP to remove difficult bile duct stones through the tract.

AN ACCOUNT OF 15 YEARS EXPERIENCE OF LAPAROSCOPIC COMMON BILE DUCT EXPLORATION IN CHOLEDOCHOLITHIASIS FOLLOWED BY PRIMARY REPAIR AND ITS COMPARISON WITH OPEN CHOLEDOCHOLITHOTOMY IN DISHARI HEALTH POINT PRIVATE LIMITED, MALDA

2021 ◽  
pp. 15-16
Author(s):  
Arkaprovo Roy ◽  
Manabesh Pramanik
Keyword(s):  
Retrospective Study ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Open Surgery ◽  
Primary Repair ◽  
Common Bile Duct Exploration ◽  
Laparoscopic Bile Duct Exploration

A retrospective study of 4628 patients who underwent laparoscopic cholecystectomies with choledocholithotomy with primary repair of common bile duct , with a mean follow-up of 23.2 months is carried outto evaluate the safety and feasibility of laparoscopic choledocholithotomy via choledochotomy for the treatment of choledocholithiasis in Dishari Health Point Private Limited, a multispeciality hospital in Malda from January 2004 to January 2019. We had to convert to open surgery in 27 patients and could complete the operation laparoscopically in rest 4621 patients. We also did open surgery in 30 patients apart from this. We analyse the results and it was found that Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis.

Primary Closure Versus T-Tube Drainage Following Laparoscopic Common Bile Duct Exploration in Patients With Previous Biliary Surgery

2020 ◽  
pp. 000313482094739
Author(s):  
Wan Zhen ◽  
Wang Xu-Zhen ◽  
Fu Nan-Tao ◽  
Li Yong ◽  
Xiao Wei-Dong ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Closure ◽  
Common Bile Duct Exploration ◽  
Biliary Surgery ◽  
Tube Drainage ◽  
T Tube ◽  
Significant Difference ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) has been recently introduced for management of CBD stone in patients with previous biliary surgery history. The aim of this study was to evaluate the safety and effectiveness of primary closure in patients with previous biliary surgery history compared to T-tube drainage. Eighty patients with previous biliary surgery history including laparoscopic cholecystectomy, open cholecystectomy, or open common bile duct exploration were enrolled in the retrospective study. The patients were divided into 2 groups according to the methods of choledochotomy closure. Group A: patients with primary closure after LCBDE (n = 51); group B: patients with T-tube drainage after LCBDE (n = 29). Group A exhibited a shorter postoperative hospital stay and lower hospitalization expenses compared to group B. There was no significant difference in conversion rate to open surgery, operating time, intraoperative blood loss, bile leakage rate, overall complication rate, and stone recurrence rate between the 2 groups. Biliary stricture was not observed in the 2 groups during the follow-up period. Primary closure following LCBDE is safe and effective for the management of CBD stones in patients with previous biliary surgery history.

Two-Port Laparoscopic Common Bile Duct Exploration with T-tube Choledochostomy for Management of Choledocholithiasis: An Initial Clinical Report

2011 ◽  
Vol 77 (4) ◽  
pp. 422-425
Author(s):  
Ding-Ping Sun ◽  
Wen-Ching Wang ◽  
Kuo-Chang Wen ◽  
Kai-Yuan Lin ◽  
Yi-Feng Lin ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Standard Procedure ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Tube Placement ◽  
Clinical Report ◽  
T Tube ◽  
Cbd Stones

Laparoscopic common bile duct exploration (LCBDE) is generally performed using a four- or five-port technique. We report a unique technique of two-port transcholedochal LCBDE with T-tube placement. Twelve consecutive patients with common bile duct (CBD) stones underwent LCBDE through two entry ports, one homemade single port (Uen port) inserted in a 2-cm umbilical wound and one 5-mm subxiphoid trocar port. With the assistance of a 1.2-mm needle that was inserted through a right lower intercostal space into the abdominal cavity to facilitate the operation, two-port dome-down laparoscopic cholecystectomy, choledochotomy, choledochoscopic removal of ductal caculi, and T-tube choldochostomy were performed with conventional methods using standard laparoscopic instruments along with manually operated angled shafts. After completion of the operation, the T-tube catheter was brought out through the subxiphoid trocar wound. All operations were completed successfully without the need of additional ports. There was no complication and no residual stones. Mean operation time was 120 minutes (range, 90 to 150 minutes), and mean postoperative hospital stay was 3.5 days (range, 3 to 4 days). Scarless wound healing was achieved except one T-tube scar. Two-port transumbilical LCBDE with T-tube choledochostomy is a feasible, safe, and effective technique that allows one-scar abdominal surgery for treatment of CBD stones. Further studies and the development of better instruments are necessary before this can be recommended as a standard procedure.

scholarly journals Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

2018 ◽  
Vol 103 (7-8) ◽  
pp. 339-343
Author(s):  
Wenwu Cai ◽  
Ke Pan ◽  
Qinglong Li ◽  
Xiongying Miao ◽  
Chang Shu
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Good Prognosis ◽  
Spontaneous Perforation ◽  
Repair Operation

Spontaneous perforation of the left intrahepatic bile duct is extremely rare, especially in adults. Here, we report on a case of a 64-year-old woman who had a complaint of right upper abdominal pain for 10 days, which gradually progressed to entire abdominal pain for 3 days, and was admitted to our hospital. Relevant examinations revealed she had a normal cardiac and lung workup, but an obvious abnormal abdominal computed tomography examination, which revealed an enlarged gallbladder, choledocholithiasis with dilatation of the common bile duct (1.8 cm) and intrahepatic bile duct, and a lot of encapsulated ascites. After being given adequate fluid resuscitation and active preoperative preparation, cholecystectomy and common bile duct exploration and perforation repair operation were then performed. The postoperative course was uneventful, and she was discharged with the T-tube in situ. A choledochoscopy examination at week 6 showed the conditions of the intrahepatic and extrahepatic bile duct were good. For these patients, early diagnosis and surgical treatment are essential for good prognosis. The goal of our surgery is to stop bile leakage, resolve choledocholithiasis and cholangitis, and reconstruct the bile duct.

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