scholarly journals Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones

2010 ◽  
Vol 92 (3) ◽  
pp. 206-210 ◽  
Author(s):  
James Horwood ◽  
Fayaz Akbar ◽  
Katherine Davis ◽  
Richard Morgan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leak ◽  
Bile Duct Stones ◽  
Operative Cholangiography ◽  
Cbd Stones ◽  
Open Operation ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Positive Results

INTRODUCTION Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis, and aimed to identify the factors most likely to predict the presence of CBD stones positively. PATIENTS AND METHODS Data from 501 consecutive patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gallstones, of whom 166 underwent IOC for suspected CBD stones, were prospectively collected. Suspicion of choledocholithiasis was based upon: (i) deranged liver function tests (past or present); (ii) history of jaundice (past or present) or acute pancreatitis; (iii) a dilated CBD or demonstration of CBD stones on imaging; or (iv) a combination of these factors. Patient demographics, intra-operative findings, complications and clinical outcomes were recorded. RESULTS Sixty-four cholangiograms were positive (39%). All indications for cholangiogram yielded positive results. Current jaundice yielded the highest positive predictive value (PPV; 86%). A dilated CBD on pre-operative imaging gave a PPV of 45% for CBD calculi; a history of pancreatitis produced a 26% PPV for CBD calculi. Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms. Of the 64 patients having a laparoscopic common bile duct exploration (LCBDE), four (6%) required endoscopic retrograde cholangiopancreatography (ERCP) for retained stones (94% successful surgical clearance of the common bile duct) and one (2%) for a bile leak. Of the 335 patients undergoing LC alone, three (0.9%) re-presented with a retained stone, requiring intervention. There were 12 (7%) requiring conversion to open operation. CONCLUSIONS A selective policy for intra-operative cholangiography yields acceptably high positive results. Pre-operatively, asymptomatic bile duct stones rarely present following LC; thus, routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore, a rationing approach to the use of intra-operative imaging based on the pre-operative indicators presented in this paper, successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration, performed by an experienced laparoscopic surgeon, is a safe and effective method of clearing the bile duct of calculi, with minimal complications, avoiding the necessity for an additional intervention and prolonged hospital stay.

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 Primary Choledocholithiasis 15 Years Postcholecystectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Simon ◽  
Irfan Nazir Hassan ◽  
Dhanasekaran Ramasamy ◽  
David Wilson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Standard Treatment ◽  
Case Reports ◽  
Gallstone Disease ◽  
The Elderly ◽  
Western Society ◽  
Bile Duct Stones ◽  
Symptomatic Gallstones

Gallstone disease is extremely prevalent in the western society with laparoscopic cholecystectomy (LC) being the standard treatment for patients with symptomatic gallstones. The prevalence of common bile duct (CBD) stones with concomitant gallstones increases with age from 8–15% in patients <60 years of age and up to 60% in the elderly. There have been only a few case reports of postcholecystectomy bile duct stones occurring more than 10 years following surgery in the literature. Most of these reports describe the presence of stones within the gallbladder/cystic duct remnant or secondary to migrating surgical clips.

Percutaneous Treatment of Common Bile Duct Stones: Results and Complications in 110 Consecutive Patients

2015 ◽  
Vol 32 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Johan F. Kint ◽  
Janneke E. van den Bergh ◽  
Rogier E. van Gelder ◽  
Erik A. Rauws ◽  
Dirk J. Gouma ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Alternative Treatment ◽  
Common Bile Duct Stones ◽  
Pleural Empyema ◽  
Percutaneous Treatment ◽  
Bile Duct Stones ◽  
Cbd Stones ◽  
Percutaneous Extraction ◽  
Number Of Treatment

Background/Aims: Choledocholithiasis is a common complication of cholecystolithiasis, occurring in 15-20% of patients who have gallbladder stones. Endoscopic retrograde cholangio-pancreatography is the standard treatment. When this is not possible or not feasible, percutaneous transhepatic stone removal is an alternative treatment. In this retrospective study, we analyze 110 patients who were treated with percutaneous transhepatic removal of Common Bile Duct (CBD) stones. Patients and Methods: Between March 1998 and September 2013 110 patients (61 men, 49 women; aged 14-96, mean age 69.7 years) with confirmed bile duct stones were included. PTC was done using ultrasound and fluoroscopy. Balloon dilatation of the papilla was done with 8-12 mm balloons. If stone size exceeded 10 mm, mechanical lithotripsy was performed. Stones were then removed by percutaneous extraction or evacuation into the duodenum. Results: In 104 patients (104/110; 94.5%) total stone clearance of the CBD was achieved. A total of 12 complications occurred (10.9%), graded with the Clavien-Dindo scale as IVa, IVb, and V, respectively; hypoxia requiring resuscitation, sepsis and death due to ongoing cholangiosepsis (n = 1, 4, 1). Minor complications I, II, and IIIa included: small liver abscess, pleural empyema, transient hemobilia and mild fever (n = 1, 1, 2, 2). Conclusion: Percutaneous removal of CBD stones is an effective alternative treatment, when endoscopic treatment is contra-indicated, fails or is not feasible. It is effective, has a low complication rate and using deep sedation potentially requires only a very limited number of treatment sessions.

scholarly journals Increased Prevalence of Subclinical Hypothyroidism in Common Bile Duct Stone Patients

2007 ◽  
Vol 92 (11) ◽  
pp. 4260-4264 ◽  
Author(s):  
Johanna Laukkarinen ◽  
Gediminas Kiudelis ◽  
Marko Lempinen ◽  
Sari Räty ◽  
Hanna Pelli ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Subclinical Hypothyroidism ◽  
Sphincter Of Oddi ◽  
Liver Function Tests ◽  
Control Group ◽  
Cbd Stones ◽  
History Of ◽  
Cbd Stone ◽  
Previous Medical History

Abstract Context: Earlier, we have shown an increased prevalence of previously diagnosed hypothyroidism in common bile duct (CBD) stone patients and a delayed emptying of the biliary tract in hypothyroidism, explained partly by the missing prorelaxing effect of T4 on the sphincter of Oddi contractility. Objective: In this study, the prevalence of previously undiagnosed subclinical hypothyroidism in CBD stone patients was compared with nongallstone controls. Patients: All patients were clinically euthyreotic and without a history of thyroid function abnormalities. CBD stones were diagnosed at endoscopic retrograde cholangiopancreatography (group 1; n = 303) or ruled out by previous medical history, liver function tests, and ultrasonography (control group II; n = 142). Main Outcome Measures: Serum free FT4 and TSH (S-TSH) were analyzed; S-TSH above the normal range (&gt;6.0 mU/liter) was considered as subclinical and S-TSH 5.0–6.0 mU/liter as borderline-subclinical hypothyroidism. Results: A total of 5.3 and 5.0% (total 10.2%; 31 of 303) of the CBD stone patients were diagnosed to have subclinical and borderline-subclinical hypothyroidism, compared with 1.4% (P = 0.05) and 1.4% (total 2.8%, four of 142; P = 0.026) in the control group, respectively. In women older than 60 yr, the prevalence of subclinical hypothyroidism was 11.4% in CBD stone and 1.8% in control patients (P = 0.032) and subclinical plus borderline-subclinical hypothyroidism 23.8% in CBD stone and 1.8% in control patients (P = 0.012). Conclusion: Subclinical hypothyroidism is more common in the CBD stone patients, compared with nongallstone controls, supporting our hypothesis that hypothyroidism might play a role in the forming of CBD stones. At minimum, women older than 60 yr with CBD stones should be screened for borderline or overt subclinical hypothyroidism.

scholarly journals Closing common bile duct after laparoscopic cholecystectomy and biliary stone extraction combined flexible fiberoptic choledochoscope

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Trọng Hiền Dương ◽  
Trung Nghĩa Nguyễn
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leak ◽  
Site Infection ◽  
Bile Duct Stones ◽  
Stone Extraction ◽  
Effective Technique ◽  
Biliary Stone

Tóm tắt Đặt vấn đề: Nghiên cứu nhằm đánh giá kết quả sớm điều trị bệnh nhân sỏi túi mật và ống mật chủ (OMC) được phẫu thuật nội soi (PTNS) kết hợp kiểm soát OMC (KS-OMC) bằng nội soi ống mềm tại Bệnh viện HN Việt Đức. Phương pháp nghiên cứu: 12 bệnh nhân (Nam/Nữ: 5/7) được khâu kín OMC sau PTNS cắt túi mật và lấy sỏi OMC có dùng nội soi đường mật ống mềm. Kết quả: Thời gian phẫu thuật trung bình: 145 ± 45 phút, lượng máu mất 70 ± 50ml (Lượng máu mất từ: 50ml tới 150 ml); các biến chứng trong mổ: không, biến chứng rò mật sau mổ: không, biến chứng nhiễm trùng vết mổ: 1 trường hợp; thời gian nằm viện trung bình 8 ± 1,5 ngày (Thời gian từ: 6 tới 10 ngày) Kết luận: Khâu kín OMC sau phẫu thuật nội soi cắt túi mật và lấy sỏi OMC có kiểm tra bằng nội soi đường mật ống mềm là an toàn và hiệu quả. Abstract Introduction: The objectives of study were to evaluate the early result of treatment patients with concomitant gallbladder stones and common bile duct (CBD) stones by laparoscopic surgery in using flexible fiberoptic choledochoscope. Material and Methods: There were 12 patients enrolled (male/female: 5/7) who are sutured bile duct after laparoscopic cholecystectomy and removing stones in common bile duct with cholangioscopy. Results: Average surgery time: 145 ± 45 min, blood loss 70 ± 50 ml, no postoperative complications related to the procedure. There is no bile leak. There is one surgical site infection, mean hospital stay of 8 ± 1,5 days (6 to 10 days). Conclusion: The current study suggests that laparoscopic surgery and using cholangioscopy to controlling bile duct for the management of cholecysto-choledocholithiasis is a safe and effective technique. Keywords: Gallstones, bile duct stones.

scholarly journals Safety and efficacy of laparoscopic versus open surgery in management of common bile duct stones: experience at the Sohag University Hospital, Egypt

2018 ◽  
Vol 5 (11) ◽  
pp. 3727 ◽  
Author(s):  
Mena Z. Helmy ◽  
Ahmed E. Ahmed
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Bile Leak ◽  
University Hospital ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Cbd Stones

Background: Management of common bile duct (CBD) stones includes removal of the gallbladder and clearance of the ductal system which can be achieved through different approaches; endoscopic, laparoscopic or surgical.  Objective of this study is to assess the safety, efficacy, technical feasibility and surgical outcomes of laparoscopic common bile duct exploration (LCBDE) versus open surgery in the treatment of patients with cholidocholithiasis.Methods: From June 2015 to December 2017, 120 patients with CBD stones were prospectively treated at Sohag University Hospital, Upper Egypt. Patients were divided into two groups: the first one treated by LCBDE (60 patients), while the other group treated by open surgery (60 patients).Results: The ages of our patients were ranged from 20 to 80 (mean = 40) years, with a female predominance (female/male = 74/46). Patients in the first group were treated by laparoscopic approaches: transcystic approaches in four patients and transcholedochotomy approaches in 56 patients. Choledochoscop was routinely used to detect, extract the stones, in addition to assessment of CBD clearance. The conversion rate was done in two cases. The operative time was 120 (90-220) min, the clearance of CBD stones was achieved in 98.4% of cases (one case of missed stones). Hospital stay was 3 (2-4) days, with no mortality, morbidity rate was 5% including bile leak, and missed stone. The operative time in the second group was 100 (80-180) min, the clearance of CBD stones was achieved in 96.6% of cases (two cases of missed stones). Hospital stay was 8 (5-12) days, with no mortality; the morbidity rate was 15% in the form of wound infection, bile leak, missed stone and ileus.Conclusions: Management of cholidocholithiasis by laparoscopic approach is feasible, effective and safe procedure with good outcome and high success rate. 

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