scholarly journals LAPAROSCOPIC APPROACH OF THE MAIN BILE DUCT IN TREATMENT OF CHOLEDOCHOLITHIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
P Gil Vázquez ◽  
D Ferreras Martínez ◽  
B Gómez Pérez ◽  
F Sánchez-Bueno
Keyword(s):  
Cost Effectiveness ◽  
Bile Duct ◽  
Hospital Stay ◽  
Therapeutic Option ◽  
Laparoscopic Approach ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Single Center Study ◽  
Safe Technique ◽  
Effectiveness Index

Abstract INTRODUCTION The aim is to analyze the validity and safety of a new program of laparoscopic common bile duct exploration (LCBE) in the treatment of choledocholithiasis (CD), evaluating hospital stay and cost-effectiveness. MATERIAL AND METHODS Today, there is controversy over which is the best therapeutic option in choledocholithiasis: preoperative ERCP followed by laparoscopic cholecystectomy (LC) versus LCBE. We designed this prospective, non-randomized, single-center study with 118 patients (67 women and 51 men, a mean age of 69.8 ± 17.3 years old). Sixty-six patients began a two-stage management (ERCP + LC), failing to clean the bile duct by endoscopy in 15 cases. LCBE was performed in 59 patients (49 at the beginning and 11 after ERCP failure). Seven of them required conversion to open surgery. RESULTS LCBE approach was more effective in cleaning the bile duct than ERCP (88.1% vs 72.7%; p = 0.032) with no statistics differences in terms of postoperative morbidity or mortality. In the multivariate analysis, the LCBE was an independent factor in the reduction of hospital stay and the economic costs derived from the management of these patients, reducing it 6.13 days (CI95% 2.98 - 9.27; p < 0.001) the hospital stay and 3,218.16€ (CI95% 1,082.4 - 5,354.8; p = 0.001) the costs respect to the classical approach, with an incremental cost-effectiveness index (CEI) of -209. CONCLUSION LCBE is an effective and safe technique. It significantly reduces hospital stay and costs derived from the management of the patients with choledocholithiasis.

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.

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.

scholarly journals P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Critical View Of Safety ◽  
Novel Technique ◽  
Increased Risk ◽  
Time Required

Abstract Background Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD. Methods Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated. Results This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery. Conclusions The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated. 

scholarly journals Laparoscopic trans-cystic common bile duct exploration and treatment of choledocholithiasis in a patient with Roux-en-Y reconstruction after gastrectomy: report of an emergency case

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Marco Giacometti ◽  
Francesco Battafarano ◽  
Orazio Geraci ◽  
Sandro Zonta
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Total Gastrectomy ◽  
Laparoscopic Approach ◽  
Common Bile Duct Exploration ◽  
Direct Vision ◽  
Emergency Case ◽  
The Common ◽  
Reconstruction After Gastrectomy

Abstract We present the case of choledocholithiasis with purulent cholangitis treated with laparoscopic approach in a patient with Roux-en-Y reconstruction after total gastrectomy. After cholangiography, the common bile duct was explored with trans-cystic choledochoscopy and the retained stone extracted under direct vision.

Risk factors and consequences of conversion to open surgery in laparoscopic common bile duct exploration

2018 ◽  
Vol 32 (12) ◽  
pp. 4990-4998 ◽  
Author(s):  
Bin Xu ◽  
Yu-Xiang Wang ◽  
Yong-Xin Qiu ◽  
Hong-Bo Meng ◽  
Jian Gong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Open Surgery ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery

scholarly journals O-EGS03 Laparoscopic surgery versus Endoscopy in the management Common Bile Duct Stones: systematic review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Hafs Elhag ◽  
Omar Eltayeb
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Acute Cholangitis ◽  
Surgical Site Infections ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Duration Of Hospital Stay ◽  
Cbd Stones

Abstract Background With the advancement in minimally invasive surgery, a 1 stage Laparoscopic Common Bile Duct Exploration (LCBDE) followed by Laparoscopic Cholecystectomy (LC) is a great alternative to removing the gallbladder and CBD stones provided the surgeon possesses the necessary skills. The current guidelines for managing CBD stones is the 2 stage approach, Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by (LC). The objective of this study is to assess whether LCBDE+LC should be the gold standard in managing CBD stones by comparing the clearance rate of common bile duct stones, morbidity, mortality, and the duration of hospital stay with ERCP+LC. Methods This is a systematic review with a meta-analysis that included RCTs of patients who were treated by the LCBDE/LC versus ERCP+LC. The PRISMA guidelines for reporting systemic reviews were followed. RCTs were collected by 2 authors Independently from Cochrane Central Register of Controlled Trials, Medline and Embase. Statistical analysis was carried out by a computer application called Review Manager using the Mantel–Haenszel method, the results were then plotted on a Forest Plot diagram and the 2 groups were then compared. Results 849 patients from 7 RCTs were included in the study, 426 patients in the ERCP+LC arm and 423 in the LCBDE/LC arm. According to the Meta-analysis, Laparoscopic Common Bile Duct Exploration with Cholecystectomy was significantly superior to ERCP + LC in terms of successful Clearance of CBD stone, mortality rate, and Acute Pancreatitis. but had significantly higher rates in biliary leakages. There were no significant differences in Surgical Site Infections, Haemorrhages, Acute Cholangitis, Perforations, or duration of hospital stay between the two arms. Conclusions The current evidence suggests that LCBDE/LC is superior in successful CBD stone clearance, mortality, and acute pancreatitis. However, further RCTs will be needed to assess overall Morbidity, surgical site infections, Haemorrhages, Acute Cholangitis, perforations, or duration of hospital stay. The current guidelines must be reviewed to consider LCBDE/LC as the gold standard in managing patients with CBD stones.

scholarly journals Common Bile Duct Exploration in an Elderly Asian Population

2015 ◽  
Vol 100 (2) ◽  
pp. 261-267 ◽  
Author(s):  
Vishal G. Shelat ◽  
Vincent J. M. Chia ◽  
JeeKeem Low
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Laparoscopic Approach ◽  
Asian Population ◽  
Laparoscopic Group ◽  
The Elderly ◽  
Common Bile Duct Exploration ◽  
Group A ◽  
Group B

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 (&gt;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 &lt; 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.

“Conversion to open surgery during laparoscopic common bile duct exploration: Predictive factors and impact on the perioperative outcomes”

HPB ◽  
2021 ◽  
Author(s):  
Carmen Payá-Llorente ◽  
Carlos Domingo-del Pozo ◽  
Paula Gonzálvez-Guardiola ◽  
Sandra Santarrufina-Martínez ◽  
Eugenia Pareja-Ibars ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Predictive Factors ◽  
Open Surgery ◽  
Common Bile Duct Exploration ◽  
Perioperative Outcomes ◽  
Conversion To Open Surgery

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

2020 ◽  
pp. 000313482094952
Author(s):  
Bertram Marks ◽  
Ahmad Al Samaraee
Keyword(s):  
Systematic Review ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Open Surgery ◽  
Bile Leak ◽  
Common Bile Duct Exploration ◽  
Duration Of Hospital Stay ◽  
Published Evidence ◽  
The Common

Introduction Endoscopic and open surgical interventions are widely implemented as the standard practice in common bile duct exploration. However, the laparoscopic approach has been also reported to have comparative/superior outcomes in this concept. This has created an ongoing debate about the ideal approach to adopt in practice. Methods A systematic review of the published evidence over the last decade that has looked into the outcomes of laparoscopic exploration of the common bile duct through transductal and transcystic approaches. Results Our systematic review included 36 relevant papers. The majority were based on nonrandomized protocols conducted in single centers with high expertise. The data analysis showed that laparoscopic common bile duct exploration through both approaches was successful in more than 84% of the patients, with an average length of hospital stay of 5.6 days. Conversion to open surgery was reported in 5%-8% of the patients, and the bile leak rates from the more recent studies was 0%-12%, with mortality figures of 0%-1.3%. The outcomes were statistically in favor of the transcystic route when compared to the transductal route from the viewpoints of bile leak rates, mean operative time, duration of hospital stay and morbidity. Conclusion In experienced hands, both laparoscopic approaches in common bile duct exploration are safe in patients who are clinically fit to have this intervention. It is associated with a statistically significant lower overall morbidity and shorter duration of hospital stay when compared to open surgery. Relevant up-to-date high-quality randomized trials are unavailable.

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