scholarly journals Open bile duct exploration as a therapeutic solution for difficult to manage choledocholithiasis: a case report

2021 ◽  
Author(s):  
Eduardo Poblano Olivares ◽  
Brenda Soto Perez ◽  
Jorge L. Olmos Gonzalez
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Clinical Suspicion ◽  
Minimally Invasive Procedures ◽  
Bile Duct Stones ◽  
Invasive Procedures ◽  
Duct Obstruction ◽  
Intrahepatic Stones ◽  
Common Etiology ◽  
Therapeutic Alternatives

The most common etiology of bile duct obstruction in patients with cholelithiasis is choledocholithiasis. The diagnosis of cholelithiasis is based on clinical suspicion and confirmed by ultrasound (US) of the liver and bile ducts. The management of bile duct lithiasis has evolved considerably and currently, ERCP is the most common and recommended technique. However, in cases of multiple lithiases, fragmentation of the lithiasis during extraction, excessive preoperative or transoperative handling of the ampullary region, previous stenosis of the ampullary region, juxtapapillary diverticula, primary bile duct stones, or residual intrahepatic stones, a large number of hospitals do not have sufficient resources to perform minimally invasive procedures and offer these therapeutic alternatives instead.  

scholarly journals Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

2007 ◽  
Vol 44 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Ralf Jakobs ◽  
Julio C. Pereira-Lima ◽  
Aline W. Schuch ◽  
Lucas F. Pereira-Lima ◽  
Axel Eickhoff ◽  
...  
Keyword(s):  
Bile Duct ◽  
Laser Lithotripsy ◽  
Bile Duct Stones ◽  
Distal Bile Duct ◽  
Laser Guidance ◽  
Endoscopic Papillotomy ◽  
Intrahepatic Stones ◽  
Bile Duct Stenosis ◽  
Extracorporeal Shock Wave ◽  
Fluoroscopic Control

BACKGROUND: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed. AIM: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy. METHODS: Between 1992 and 2002 we have treated 89 patients with difficult bile duct stones by endoscopic retrograde cholangiopancreatography and laser lithotripsy. Unsuccessful extracorporeal shock-wave lithotripsy and electrohydraulic were also performed before laser in 35% and 26% of the cases, respectively. RESULTS: Laser was effective in 79.2% of 72 patients guided by cholangioscopy and in 82.4% of 17 cases steered by fluoroscopy. The median number of impulses in the latter was 4,335 and 1,800 with the former technique. Two parameters influenced the manner of laser guidance. In cases of stones situated above a stricture, cholangioscopic control was more effective (64.7% vs. 31.9%). When the stones were in the distal bile duct, fluoroscopic control was more successful. CONCLUSION: In cases of difficult stones in the distal bile duct, laser lithotripsy under fluoroscopic control is very effective and easily performed. Cholangioscopic guidance should be recommended just in cases of intrahepatic stones or in patients with stones situated proximal to a bile duct stenosis. In these cases, cholangioscopy should be performed either endoscopically or percutaneously.

scholarly journals Liver Resection for Intrahepatic Stones

HPB Surgery ◽  
1990 ◽  
Vol 2 (2) ◽  
pp. 145-147 ◽  
Author(s):  
Roland Andersson ◽  
Karl-Göran Tranberg ◽  
Stig Beng-Mark
Keyword(s):  
Liver Resection ◽  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Liver Parenchyma ◽  
Long Term Results ◽  
Bile Duct Stricture ◽  
Bile Duct Stones ◽  
Intrahepatic Stones ◽  
Duct Stricture

Intrahepatic stones are difficult to manage, especially when they are associated with bile duct stricture, cholangitis and destruction of liver parenchyma. Suggested modes of treatment include surgical bile duct exploration, endoscopic procedures, transhepatic cholangiolithotomy and liver resection. This paper reports 2 patients in whom liver resection was performed because of intrahepatic ductal stones, bile duct strictures and repeated episodes of cholangitis. Liver resection was uncomplicated and long-term results were satisfactory. Our results support the view that liver resection is indicated in rare instances of intrahepatic bile duct stones associated with bile duct strictures.

scholarly journals Results of laparoscopic for the management of bile duct stones

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Quoc Phong Le ◽  
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Bile Ducts ◽  
Clinical Characteristics ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
Open Conversion ◽  
Laparoscopic Choledochotomy

Abstract Introduction: To describe clinical and para-clinical characteristics of bile duct stones and results of laparoscopic choledochotomies in management of bile duct stones. Materials and methods: Retrospective and prospective study in 152 bile duct stones patient, who underwent laparoscopic choledochotomy with or without usage of flexible bile ducts scope and electrohydraulic technique, from January 2009 to May 2019 at Hue Central Hospital. Results: Mean age 54,2 (22 - 84), 66 male and 86 female, mean operative time: 135 minutes (90 - 235), intraoperative complications: 3,29%, open conversion: 5,92%. Complete stone clearance was achieved in 91,6% patients. Postoperative complications: 7,69%. Conclusions: Managementofbileductstonesbylaparoscopiccholedochotomy is safe and effective with high percentage of stones clearence, as well as low intraoperative and postoperative complications. This procedure can achieve good results if bile ducts scope and electrohydraulic technique were concomitantly applied.

scholarly journals Review Article: Spectrum of Biliary Infections in the West and in the East

HPB Surgery ◽  
1995 ◽  
Vol 8 (4) ◽  
pp. 215-222 ◽  
Author(s):  
H. G. Beger ◽  
A. Schwarz
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Population ◽  
Common Bile Duct Stones ◽  
Western World ◽  
Bile Pigment ◽  
Bile Duct Stones ◽  
The West ◽  
Intrahepatic Stones ◽  
Male To Female

Biliary infections are an important cause of morbidity in the Western world. With regard to epidemiology, etiology, microbiological spectrum, prevalence, location and composition of gallstones, pathogenesis, clinical sign and therapy, there are large differences between the spectrum of biliary infections in the East and in the West (Table 1). In Western countries, gallstones are found in 10 to 40%. In Eastern countries, the incidence of gallstones is only 2 to 6%. Some eighty – five percent of the gallstones in the West are cholesterol stones, in contrast to the East, where 97% are bile pigment stones. The most important difference is characterized by the origin of common bile duct stones. In the West, common bile duct stones generally originate in the gallbladder, in contrast to the East, where primary common bile duct stones are often found – especially in the intrahepatic segments – with no evidence of gallbladder stones. The sex distribution male to female in the West is 1:2, in the East 1:1. In the West, biliary infections occur mainly in an elderly population, 50% being older than 70 years. In the East, biliary infections appear also in younger people, 50% being younger than 40 years. Parasites play an aetiological role in the East, but not in the West. The typical therapy of gallstones in the West is cholecystectomy, and of common bile duct stones endoscopic sphincterotomy. Due to the frequency of intrahepatic stones in Eastern Countries, the therapeutic spectrum there includes even large hepatic resections and biliary enteric anastomoses.

Bile Ducts and Bile Duct Stones

1997 ◽  
Vol 45 (3) ◽  
pp. 340
Author(s):  
Jeffrey L. Ponsky
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Bile Duct Stones

scholarly journals TRANSFISTULAR NANOELECTROIMPULSE LITHOTRIPSY IN THE TREATMENT OF CHOLEDOCHOLITHIASIS

2019 ◽  
Vol 21 (1) ◽  
pp. 25-28
Author(s):  
A I Babak ◽  
E A Mozhaeva ◽  
D A Raskovalov ◽  
I S Andrienko ◽  
M I Prudkov
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
New Method ◽  
Bile Duct Stones ◽  
Duodenal Papilla ◽  
Nanosecond Duration ◽  
Safe Method ◽  
Electrohydraulic Lithotripsy ◽  
Major Duodenal Papilla ◽  
Highly Effective

In 2003, Russian developers proposed a new method of crushing stones by electric impulses of nanosecond duration, which has several advantages over contact electrohydraulic lithotripsy. The aim of the study was to evaluate the possibilities of transfistular nanoelectroimpulse lithotripsy (NEIL) in the treatment of choledocholithiasis. A nanoelectroimpulse lithotriptor "Urolit", manufactured by Medline Ltd. (Tomsk, Russia), was used to break down the gallstones. 66 patients with large and/or unmovable bile duct stones and bile ducts drains were performed transfistular NEIL. It was successful in 63 patients (95.5%). NEIL made it possible to perform removal of large and/or unmovable gallstones without destroying the sphincters of the major duodenal papilla in 89% cases. Transfistular NEIL is a new highly effective and safe method of crushing gallstones.

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