scholarly journals Evaluation of different methods of laparoscopic treatment of common bile duct stones

2019 ◽  
Vol 6 (8) ◽  
pp. 2670
Author(s):  
Elghamry E. Elghamry ◽  
Mohamed M. Elsheikh ◽  
Hamdy A. Mohamed
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Repair ◽  
Common Bile Duct Stones ◽  
Bile Leakage ◽  
Biliary Colic ◽  
Bile Duct Stones ◽  
Cbd Stones ◽  
The Mean ◽  
Cbd Exploration

Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE).Methods: This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. Authors used transcystic and transcholedochotomy approaches for LCBDE either with or without choledoschope. Primary repair of the choledochotomy incision was done. Results: The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients. The transcystic approach for CBD exploration was used in 16 cases without conversion, 11 cases were completed without choledochoscope, while 5 cases with choledochoscopic guided extraction. Choledochotomy approach had been used in 13 cases, 6 cases were completed with choledochoscope and 7 cases without it, two cases of them failed. One case failed from the beginning and was converted to open exploration. 5 ERCP previously inserted stents were removed. The mean operative time was 162.33±74.67 min. Bile leakage occurred in 2 cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days.Conclusion: LCBDE is a feasible, effective and safe approach to bile duct stones. Depending on proper training and gaining experience. 

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 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 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 A case report of spontaneous passage of large (>1.5 cm) common bile duct calculi (4 in number) through faeces

2021 ◽  
Vol 8 (7) ◽  
pp. 2186
Author(s):  
Maliha I. Ansari ◽  
Anand S. Pandey
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Biliary Colic ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Spontaneous Passage ◽  
Pass Through ◽  
Bile Duct Calculi ◽  
Fatal Complications

Gallbladder (GB) stones are commonly associated with common bile duct stones (CBDS). While they may remain asymptomatic, some may present with symptoms like biliary colic, jaundice and cholecystitis. Most of these stones in the CBD, if small, pass through faeces. Passing larger stones through faeces is relatively rare and if it does occur, is usually associated with fatal complications like acute pancreatitis. The authors reported a case wherein symptomatic large CBD stones were spontaneously passed through faeces and the patient was relieved of the symptoms and did not suffer any further complications. Choledocholithiasis is usually managed by endoscopic retrograde cholangiopancreatography or by laparoscopic or open choledocholithotomy. Spontaneous passage of small CBD and GB calculi through faeces although common is associated often with the development of pancreatitis. Passage of large CBD calculi (size >1.5 cm) through faeces is rarely seen.

Evaluation of primary repair of common bile duct in common bile duct stones

2016 ◽  
Vol 14 (1) ◽  
pp. 29
Author(s):  
MohamedA Abdel-Raheem ◽  
AbdelmonemA Mohamed ◽  
EmadA Ibrahim ◽  
MohamedB Gaber
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Primary Repair ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones

One-step Laparoscopic and Endoscopic Treatment of Gallbladder and Common Bile Duct Stones: Our Experience of the Last 9 Years in a Retrospective Study

2013 ◽  
Vol 79 (12) ◽  
pp. 1243-1247 ◽  
Author(s):  
Andrea Liverani ◽  
Mirko Muroni ◽  
Francesco Santi ◽  
Tiziano Neri ◽  
Gerardo Anastasio ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Common Bile Duct Stones ◽  
Optimal Timing ◽  
Bile Duct Stones ◽  
One Step ◽  
The Mean ◽  
Group 2 ◽  
Group 1

The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intra-operative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. Of those, 162 patients (8.2%; male/female 72/90) presented with GBS and suspected CBDS. We treated 54 cases (Group 1) with ERCP and LC within 48 to 72 hours. In 108 patients (Group 2) we performed LC with IOC and, if positive, was associated with IO-ERCP and sphincterotomy. In Group 1, a preoperative ERCP and LC were completed in 50 patients (30%). In four cases (2%), an ERCP and endobiliary stents were performed without cholecystectomy and then patients were discharged because of the severity of clinical conditions and advanced American Society of Anesthesiologists score (III to IV). Two months later a preoperative ERCP and removal of biliary stents were performed followed by LC 48 to 72 hours later. In Group 2, the IOC was performed in all cases and CBDS were extracted in 94 patients (87%). In two cases, the laparoscopic choledochotomy was necessary to remove large stones. In another two cases, an open choledochotomy was performed to remove safely the stones with T-tube drainage. In three cases, conversion was necessary to safely complete the procedure. The mean operative time was 95 minutes (range, 45 to 150 minutes) in Group 1 and 130 minutes (range, 50 to 300 minutes) in Group 2. The mean hospital stay was 6.5 days (range, 4 to 21 days) in Group 1 and 4.7 days (range, 3 to 14 days) in Group 2. Five cases (two in Group 2 and three in Group 1) presented with CBDS at 12 to 18 months after surgery. They were treated successfully with a second ERCP. There was no perioperative mortality. Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.

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 Retrospective Analysis of Radiation Exposure During Endoscopic Retrograde Cholangiopancreatography: Critical Determinants

2011 ◽  
Vol 25 (10) ◽  
pp. 555-559 ◽  
Author(s):  
Edward Kim ◽  
Mark McLoughlin ◽  
Eric C Lam ◽  
Jack Amar ◽  
Michael Byrne ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Radiation Exposure ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Biliary Strictures ◽  
Endoscopic Retrograde ◽  
Specific Patient ◽  
Factors Associated ◽  
The Mean

BACKGROUND: Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) has a logarithmic relationship with radiation exposure, and carries a known risk of radiation exposure to patients and staff. Factors associated with prolonged fluoroscopy duration have not been well delineated.OBJECTIVES: To determine the specific patient, physician and procedural factors that affect fluoroscopy duration.METHODS: A retrospective analysis of 1071 ERCPs performed at two tertiary care referral hospitals over an 18-month period was conducted. Patient, physician and procedural variables were recorded at the time of the procedure.RESULTS: The mean duration of 969 fluoroscopy procedures was 4.66 min (95% CI 4.38 to 4.93). Multivariable analysis showed that the specific patient factors associated with prolonged fluoroscopy duration included age and diagnosis (both P<0.0001). The endoscopist was found to play an important role in the duration of fluoroscopy (ie, all endoscopists studied had a mean fluoroscopy duration significantly different from the reference endoscopist). In addition, the following procedural variables were found to be significant: number of procedures, basket use, biopsies, papillotomy (all P<0.0001) and use of a tritome (P=0.004). Mean fluoroscopy duration (in minutes) with 95% CIs for different diagnoses were as follows: common bile duct stones (n=443) 5.12 (3.05 to 4.07); benign biliary strictures (n=135) 3.94 (3.26 to 4.63); malignant biliary strictures (n=124) 5.82 (4.80 to 6.85); chronic pancreatitis (n=49) 4.53 (3.44 to 5.63); bile leak (n=26) 3.67 (2.23 to 5.09); and ampullary mass (n=11) 3.88 (1.28 to 6.48). When no pathology was found (n=195), the mean fluoroscopy time was 3.56 min (95% CI 3.05 to 4.07). Comparison usingttests determined that the only two diagnoses for which fluoroscopy duration was significantly different from the reference diagnosis of ‘no pathology found’ were common bile duct stones (P<0.0001) and malignant strictures (P<0.0001).CONCLUSIONS: Factors that significantly affected fluoroscopy duration included age, diagnosis, endoscopist, and the number and nature of procedures performed. Elderly patients with biliary stones or a malignant stricture were likely to require the longest duration of fluoroscopy. These identified variables may help endoscopists predict which procedures are associated with prolonged fluoroscopy duration so that appropriate precautions can be undertaken.

scholarly journals Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones

2020 ◽  
Author(s):  
Yadong Feng ◽  
Wei Xu ◽  
Yang Liu ◽  
Xiaomei Sun ◽  
Yan Liang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Bile Leakage ◽  
Laser Lithotripsy ◽  
Technical Success ◽  
Stone Clearance ◽  
Cbd Stones ◽  
Endoscopic Retrieval ◽  
Technical Details

Abstract Background Few studies have evaluated digital cholangioscopy (DCS) assisted non-radiation endoscopic retrograde cholangiopancreatography (NR-ERCP) for choledocholithiasis. Here, we evaluated the application of DCS assisted NR-ERCP for endoscopic retrieval of common bile duct (CBD) stones.Methods Patients who underwent ERCP for choledocholithiasis and without prior ERCP were included. Data related to technical success and outcomes of DCS-assisted NR-ERCP and conventional ERCP were retrieved and compared. Procedure and technical details of DCS assisted NR-ERCP were collated and reviewed.Results In total, 304 and 53 patients who underwent conventional and DCS-assisted ERCP were recruited. Relatively larger stones (p < 0.001) was present in DCS assisted NR-ERCP. No statistical difference was present in biliary access, lithotripsy, stone removal and total complications. A higher proportion of larger balloon for EPBD (p < 0.001) and more ERCP sessions for stone clearance (p < 0.001) were present in conventional ERCP. In DCS-assisted ERCP, technical success was achieved in 52 (98.1%) patients and DCS-guided laser lithotripsy was applied in 9 (17%) patients. DCS guided laser lithotripsy was superior to mechanical lithotripsy for stone clearance (p < 0.001) in large stones. Mean length of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6–19) and 32.96 ± 16.29 (13–82) minutes, respectively. One delayed bile-leakage, one moderate pancreatitis, two mild pancreatitis and five cases of hyperamylasemia occurred. Technical details and complications were not statistically differed between patients with a dilated and a non-dilated CBD.Conclusions DCS-based NR-ERCP is technically feasible and safe for retrieval of CBD stones. It provides an alternative to conventional ERCP for endoscopic treatment of simple choledocholithiasis.

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