Laparoscopic Common Bile Duct Exploration Is a Safe and Effective Strategy for Elderly Patients

2018 ◽  
Vol 25 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Wen-song Liu ◽  
Yong Jiang ◽  
Dong Zhang ◽  
Long-Qing Shi ◽  
Dong-Lin Sun
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Chronic Diseases ◽  
Heart Diseases ◽  
The Elderly ◽  
Common Bile Duct Exploration ◽  
Cbd Stones ◽  
Recurrent Stone

Purpose. Laparoscopic common bile duct exploration (LCBDE) has been widely used to remove common bile duct (CBD) stones. However, surgery is not considered as the first treatment choice for elderly patients with CBD stones because of the potential risk of postoperative complications. This study aims to evaluate the safety and efficiency of LCBDE for elderly patients. Methods. From April 2011 to October 2016, 265 consecutive patients underwent LCBDE. We performed a retrospective study and divided these patients into 2 groups. The younger group was younger than 70 years old (n = 179), and the elderly group was 70 years old or older (n = 86). We compared patient demographics, clinical characteristics, intraoperative parameters, postoperative complications, and incidence of recurrent stone between the 2 groups. Results. The elderly patients had higher preoperative morbidity of chronic diseases, such as pulmonary diseases, heart diseases, arterial hypertension, and abdominal operation history ( P < .05). There were no significant differences between the 2 groups in terms of operation time, intraoperative blood loss, conversion rate to open surgery, total cost, overall complications, and incidence of recurrent stone ( P > .05). Conclusion. LCBDE can also be carried out as a safe and effective approach to remove CBD stones in elderly patients, although they have higher risk of chronic diseases.

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.

scholarly journals Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones

2021 ◽  
Vol 15 (6) ◽  
pp. 1321-1323
Author(s):  
I. Sadiq ◽  
A. Malik ◽  
J. K. Lodhi ◽  
S. T. Bukhari ◽  
R. Maqbool ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leak ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Open Approach ◽  
Cbd Stones ◽  
Duration Of Surgery ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Background: Conventionally, common bile duct stones (CBDS) are removed with help of ERCP. However, if CBDS are larger than 10 mm, then the ERCP failure rate to retrieve CBDS becomes high. In that case, open or laparoscopic common bile duct exploration (LCBDE) is other alternative. In this era of minimally invasive surgery, laparoscopic CBD exploration (LCBDE) seems to be a better option than open approach, but in our set up the safety of LCBDE is questioned. Aim: To see the conversion rate as well as complications associated with LCBDE. Material & Methods: Methods: This is a retrospective analysis of data of patients who underwent Laparoscopic Common Bile Duct Exploration (LCBDE) for large CBD stones at Fatima Memorial Hospital Lahore. Results: Since 2012, 29 patients of large (≥10 mm) CBD stones were included in this study. Among them 20(69.9%) were females and 9(31.01%) were males. The mean CBD stone size was 13 mm. Stones were extracted transcystically in 4 case and Transcholedochal stone extraction was done in 25 cases. The average duration of surgery was 130 minutes, but all cases were completed successfully without converting to open approach. There was minor bile leak in 3 patients which was managed successfully without any further intervention. No other complication was observed with LCBDE and even no retained stone was reported. Conclusion: Laparoscopic CBD exploration is safe and effective method of dealing CBD stones especially of large size when the chances of ERCP failure to retrieve stones are high. Keywords: Laparoscopy, ERCP, common bile duct,

scholarly journals Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ahmad Hormati ◽  
Mohammad Reza Ghadir ◽  
Seyed Saeed Sarkeshikian ◽  
Faezeh Alemi ◽  
Majid Moghaddam ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Ursodeoxycholic Acid ◽  
The Elderly ◽  
Success Rates ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Group A ◽  
Bile Duct Stenting ◽  
Group B

Abstract Background The role of common bile duct (CBD) stenting in the establishment of bile stream in the elderly patients and the ones who are not good candidates for surgery due to not responding to treatments was well documented in previous studies. The current study aimed at investigating the effect of adding Ursodeoxycholic acid (UDCA) to CBD stenting alone in order to reduce the size of large and multiple CBD stones. Methods Clinical outcomes including success rates in CBD stones clearance, incidence of pancreatitis, perforation, bleeding, as well as, decrease in size of stones and liver enzymes after a two-month period were assessed in the UDCA + CBD stenting group. Results A total of 64 patients referring to Shahid Beheshti Hospital in Qom, Iran with multiple or large CBD stones (above three or larger than 15 mm) received standard endoscopic therapies and UDCA + CBD stenting (group B) and controls only received standard endoscopic therapies with only CBD stenting (group A). The mean reduction in the size of stones in group B was significantly higher than that of group A (3.22 ± 1.31 vs 4.09 ± 1.87 mm) (p = 0.034). There was no difference in the incidence rate of complications including pancreatitis, cholangitis, bleeding, and perforation between the two groups (P > 0.05). Conclusion Adding UDCA to CBD stenting, due to decrease in the stone size and subsequently facilitation of the stones outlet, can be considered as the first-line treatment for patients with large and multiple CBD stones. Also, in the cases with large or multi stones may be effective in reducing size and subsequently stone retrieval. Trial registry The study protocol was approved by the Ethics Committee of Qom University of Medical Sciences (ethical code: IR.MUQ.REC.1397.075); the study was also registered in the Iranian Registry of Clinical Trials (No. IRCT20161205031252N8). This study adheres to CONSORT guidelines.

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.

Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients

2016 ◽  
Vol 31 (6) ◽  
pp. 2541-2547 ◽  
Author(s):  
Chufa Zheng ◽  
Yaokui Huang ◽  
E. Xie ◽  
Dejin Xie ◽  
Yunheng Peng ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Common Bile Duct Exploration ◽  
Definitive Treatment

scholarly journals Laparoscopic Common Bile Duct Exploration for Choledocholithiasis During a Pregnancy: a Case Report

2016 ◽  
Vol 16 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Janis Lacis ◽  
Ieva Rancane ◽  
Haralds Plaudis ◽  
Evita Saukane ◽  
Guntars Pupelis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Intraoperative Ultrasound ◽  
Common Bile Duct Exploration ◽  
Dynamic Imaging ◽  
Gallbladder Motility ◽  
Cbd Stones ◽  
Nulliparous Women

SummaryIn population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8).Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3).IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

scholarly journals Laparoscopic common bile duct exploration; a preferential pathway for elderly patients

2018 ◽  
Vol 30 ◽  
pp. 13-17 ◽  
Author(s):  
T.E. Platt ◽  
K. Smith ◽  
S. Sinha ◽  
M. Nixon ◽  
G. Srinivas ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Common Bile Duct Exploration

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.

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