scholarly journals Is it time to write obituary for open choledocholithotomy in the present era of endoscopic management? Outcome of surgery for failed endoscopic extraction, retrospective study

2017 ◽  
Vol 4 (4) ◽  
pp. 1350
Author(s):  
Rajkumar Sharma ◽  
Vipan Kumar ◽  
Niraj Gupta ◽  
Kirti Rana ◽  
Amit Dogra ◽  
...  
Keyword(s):  
Bile Duct ◽  
Open Cholecystectomy ◽  
Major Complication ◽  
Endoscopic Management ◽  
Cbd Stones ◽  
Time Period ◽  
Endoscopic Extraction ◽  
Laparoscopic Cbd Exploration ◽  
Two Stages ◽  
Cbd Exploration

Background: Between 05 to 20 percent of patients undergoing cholecystectomy for gallstones, have choledocholithiasis. Treatment of the common bile duct (CBD) stones can be conducted as open cholecystectomy and open CBD exploration or laparoscopic cholecystectomy plus laparoscopic CBD exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy or sphincteroplasty (papillary dilatation) for CBD clearance. The merits and demerits of individual techniques are yet to be settled.Methods: We reviewed the outcome of patients operated at our centre after failed endoscopic clearance of CBD stones. Over a period of 03 years, total 2145 laparoscopic/open cholecystectomies were performed at our institute. In the same time period, 14 patients (06 males and 08 females) presented with choledocholithiasis after failed ERCP extraction (median age 59 years, range 29-62 years). All the patients had undergone ERCP and ± sphincterotomy/sphincteroplasty with failed clearance. None of the patient had undergone a cholecystectomy previously.Results: We performed open choledocholithotomy with T-tube drainage plus cholecystectomy in all the patients. There were no deaths and only one major complication. Surgery resulted in complete duct clearance in 93% of patients.Conclusions: Open surgery can be performed safely and effectively in patients with retained bile duct stones and surgery can be offered as primary modality of treatment over combined endoscopic management after appropriated patient selection.

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,

EP.TH.754One Year Experience of Laparoscopic Common Bile Duct Exploration in a District General Hospital Using Ambu Disposable Scope

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alsarah Diab ◽  
Jane Kilkenny ◽  
Omer Eltayeb
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
General Hospital ◽  
Average Length ◽  
Young Patients ◽  
District General Hospital ◽  
Emergency Setting ◽  
Cbd Stones ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Abstract Aim Common bile duct (CBD) stones are the most common cause of obstructive jaundice. Laparoscopic exploration of the CBD with laparoscopic cholecystectomy has been preferred to endoscopic treatment, as a single-stage modality of treatment for CBD stones. This procedure was started in a District General Hospital in May 2019 using the standard port sites and Ambu® aScope™ 2 single-use flexible scope. Methods Retrospective analysis of outcome of all laparoscopic CBD explorations done in a District General Hospital between May 2019 and September 2020. Results A total of ten laparoscopic CBD explorations were carried out during the identified period, the main indications were young patients (40%), referral by gastroenterologist (40%) and failed endoscopic retrograde cholangiopancreatography (ERCP) (20%). The mean age (±SD) was 54.7 (± 19.2) and 70% of patients were females. Two thirds of the operations were done in emergency setting, with choledochotomy approach being used in 60% of cases and primary closure in all cases. The average length of stay (±SD) after the operation was 3.1 (±1.9). Only one patient developed a haemoserous collection that required a laparoscopic washout, none of the patients required readmission. Conclusion Laparoscopic CBD exploration can be performed safely in a district general hospital, the disposable Ambu® aScope™ 2 is safe, feasible and cost-effective substitute to the reusable choledochoscope. Provision of this laparoscopic CBD exploration at district general hospital level is more convenient to patients and can reduce referrals to regional hepatobiliary units, and therefore provide a good training opportunity for surgical registrars in this setting.

scholarly journals LAPAROSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES

2020 ◽  
pp. 1-4
Author(s):  
Binit Prasad ◽  
Mukesh Kumar ◽  
Debarshi Jana
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Open Surgery ◽  
Common Bile Duct Stones ◽  
Single Stage ◽  
Bile Duct Stones ◽  
Cbd Stones ◽  
Cbd Stone ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Introduction: Common Bile Duct stones (CBD) are found in approximately 16% of the patients undergoing Laparoscopic cholecystectomy (LC). Till recently, the gold standard for treating CBD stones was endoscopic removal, if that failed, then open surgery. However, in the laparoscopic era, the best treatment for CBD stones is a matter of debate and it continues to evolve. The objective of the present study is to determine that laparoscopic CBD exploration (LCBDE) is a safe, feasible and single-stage option for the management of CBD stones. Materials and Methods :Out of the 2900 laparoscopic cholecystectomies we did selective intraoperative cholangiogram in 262 patients who were suspected to have CBD stones based on deranged liver function tests, dilated CBD with or without CBD stone on sonography or having the history of recent jaundice/pancreatitis. If CBD stone was found, either a transcystic or transcholedochal exploration was done depending on the size, site, number of stones and CBD diameter. Choledochotomy was closed over a t-tube in the majority of the patients. Primary closure of CBD was done in few patients and in one patient we placed an antegrade stent and in another we placed endoscopic stent into the CBD laparoscpically which was removed after four weeks. Results :Till date we have performed LCBDE in 64 patients. Transcystic exploration was done in 14 patients and transcholedochal exploration was done in 46 cases out of which 2 patients had minor biliary leak which settled on conservative treatment in 2-3 days. Four patients required conversion to open surgery as there were multiple stones. We did not have any major complication and on 6 months follow-up in 76% patients, none was found to have residual stone. Conclusion :The treatment of CBD stones depends on the resources available, technical limitations and the surgeon’s expertise. Laparoscopic CBD exploration is a safe, feasible and single-stage option for the management of CBD stones.

scholarly journals Novel Method for Laparoscopic Common Bile Duct Exploration Performed Using a Disposable Bronchoscope (Ambu® aScope TM)

2017 ◽  
Vol 2 (2) ◽  
pp. 49-51
Author(s):  
Yousif Mahmood Aawsaj ◽  
Ibrahim K Ibrahim ◽  
Andrew Gilliam
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Case Series ◽  
Cost Effective ◽  
Common Bile Duct Exploration ◽  
Capital Outlay ◽  
Case Surgery ◽  
Laparoscopic Cbd Exploration ◽  
The Cost ◽  
Cbd Exploration

Laparoscopic common bile duct (CBD) exploration can be performed following choledocotomy or via the trancystic approach. Laparoscopic CBD exploration is limited in some benign upper gastrointestinal units due to the cost of sterilization of the re-usable choledochoscope. We have recently published a case series confirming the safety and efficacy of the 5mm re-usable bronchoscope for CBD exploration. This case series evaluates a single-use bronchochoscope (Ambu aScopeTM) for laparoscopic CBD exploration. Data were collected from electronic records of the patients from January 2015 until December 2016; all the cases had confirmation of CBD stones. Twenty-one patients had CBD exploration using the disposable bronchochoscope. There were 7 male and 14 female (median age 42). 8 procedures were performed as emergencies and 13 were performed electively. All the cases were done laparoscopically apart from one planned as an open procedure due to previous extensive open surgery. Twenty cases had their CBD cleared using disposable bronchoscope and one needed subsequent special test follow up. Choledocotomy was performed in 15 and Tran’s cystic approach was performed in 6. No T-tube was used in the laparoscopic cases. 2 cases were performed as day case surgery. Median postoperative hospital stay was 2.5 days. In conclusion, the disposable bronchoscope is safe and effective for use in CBD exploration with results comparable to our previously published case series. It has guaranteed sterility and is cost effective compared to the re-usable bronchoscope especially when initial capital outlay, sterile processing and maintenance costs are considered.

scholarly journals Incidence of choledocholithiasis in gallstone disease

2018 ◽  
Vol 8 (1) ◽  
pp. 43-45
Author(s):  
Kishor Kumar Tamrakar ◽  
Abhishek Bhattarai ◽  
Pragya Devakota
Keyword(s):  
Minimally Invasive Surgery ◽  
Bile Duct ◽  
Bile Duct Stone ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Technical Expertise ◽  
Hospital Record ◽  
Clinical Pictures ◽  
Preoperative Examination ◽  
Cbd Exploration

Background: Five to 20% patients with cholelithiasis also have choledocholithiasis. Most of them are diagnosed during a routine preoperative examination. Objective: To study the incidence of choledocholithiasis in patients with gallstone disease. Materials and methods: This is a retrospective observational study, conducted over a period of five years from January 2009 December 2013. Hospital record of the patients with a diagnosis of gallstone disease were evaluated. Clinical pictures of the disease and incidence of choledocholithiasis in those patients were analyzed. Result: One thousand four hundred sixty were diagnosed as a gallstone disease over a period of five years. Bile duct stone was found in 59 (4.04%) patients. The median age of presentation was 55 years. Classical charcots traid was seen in 9 (15.25%) patients. Ultrasound of the abdomen detected choledocholithiasis in 44 (74.57%) patients. Fifty four (91.52%) patients were managed with open cholecystectomy and CBD exploration. Conclusion: Incidence of choledocholithiasis in patients with gallstone disease is 4.04%. Most of the choledocholithiasis were diagnosed by ultrasound of the abdomen. Even in the era of minimally invasive surgery, when facilities and technical expertise are not available choledocholithiasis has to be managed with open CBD exploration.

scholarly journals Laparoscopic Common Bile Duct Exploration for Retrieval of Impacted Dormia Basket following Endoscopic Retrograde Cholangiopancreatography with Mechanical Failure: Case Report with Literature Review

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
J. W. O’Brien ◽  
R. Tyler ◽  
S. Shaukat ◽  
A. M. Harris
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Exploration ◽  
Fogarty Catheter ◽  
Endoscopic Retrograde ◽  
Laparoscopic Case ◽  
The Common ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Dormia baskets are commonly used during endoscopic retrograde cholangiopancreatography (ERCP). One complication is basket retention, through impaction with a gallstone or wire fracture. We describe a case where the external handle of the basket snapped causing retained basket plus large gallstone impacted in the common bile duct (CBD). Following laparoscopic cholecystectomy, laparoscopic CBD exploration allowed direct stone fragmentation under vision with the choledochoscope. Fragments were removed using a choledochoscopic basket and Fogarty catheter, and the basket was withdrawn. Literature search identified 114 cases of retained baskets with management including shockwave lithotripsy (27%), papillary balloon dilatation (22%), open CBD exploration (11%), and one laparoscopic case.

scholarly journals Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 302-306 ◽  
Author(s):  
P Sanjay ◽  
C Kulli ◽  
FM Polignano ◽  
IS Tait
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Teaching Hospital ◽  
Gallbladder Disease ◽  
Critical View ◽  
Operative Cholangiography ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

INTRODUCTION There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury. SUBJECTS AND METHODS An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated. RESULTS There was a 36% (152/417) response – 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50–100 LC per year, and 22% 25–50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-oper-ative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P= 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P< 0.05). CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.

scholarly journals Various Techniques for the Surgical Treatment of Common Bile Duct Stones: A Meta Review

2009 ◽  
Vol 2009 ◽  
pp. 1-12 ◽  
Author(s):  
Abolfazl Shojaiefard ◽  
Majid Esmaeilzadeh ◽  
Ali Ghafouri ◽  
Arianeb Mehrabi
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Biliary Colic ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Biliary Sphincterotomy ◽  
Meta Review ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

Common bile duct stones (CBDSs) may occur in up to 3%–14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal), or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure) are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.

scholarly journals Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Open Cholecystectomy ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Controlled Study ◽  
Stone Extraction ◽  
The Mean ◽  
Cbd Exploration

Abstract Objectives: Many options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with the choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the common bile duct (CBD). For this purpose, we modified the surgical modality of laparoscopic transcystic approach by dilating the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, the aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE.Patients and methods: Sixty-eight patients were arbitrarily offered new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or the columnar dilation balloon. Subsequently, the CBD exploration and stone extraction were performed with choledochoscope. The entrance of CBD was covered with cystic duct stump wall and primarily closed at the end of surgery.Results: 49 females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 yr). Of which, 62 cases (91.2%) were performed with LTD-CBDE techniques successfully, bile leakage was observed in 3 cases (4.4%). The mean operation time was 106 minutes and the mean hospital stay was 5.9 days. As for the other 6 patients, 3 cases were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at the Calot’s triangle (n=2) and Mirizze syndrome (n=1); LCBDE were performed in 3 patients due to cystic duct atresia (n=2) and low level of the gallbladder duct into CBD (n=1). These patients had smooth postoperative course. None of the patients presented radiological evidence of retained CBD stone on the postoperative follow-up in 43/68 (40 cases used LTD-CBDE) patients one year later.Conclusion: The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low rate of complications. It offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled study is further needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

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