scholarly journals Common bile duct stones: its different aspects of presentation and management

2020 ◽  
Vol 7 (7) ◽  
pp. 2289
Author(s):  
Nishant Kumar
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Medical Sciences ◽  
Radiological Findings ◽  
Cbd Stones ◽  
The Mean ◽  
Cbd Stone ◽  
Surgery Department ◽  
Potential Challenge

Background: Common bile duct (CBD) stone management is a commonly occurring potential challenge for surgeons.Methods: A total of 38 patients who was admitted in admitted in surgery Department of Sri Ram Institute of Medical Sciences, Bareilly UP during the period of March 2019 to September 2019 were studied. The diagnosis was made using USG MRCP, relevant blood investigations. Patients were managed based on radiological findings by the best possible way and expertise available.Results: Out of the 38 patients, 14 (37.14%) were male and 24 (62.85%) were female. The mean age for male was 50.92 years and for female, it was 51.74 yrs. Most of the patients had pain abdomen and /or jaundice with a mean total bilirubin of 3 mg/dl. Patients are managed either by ERCP or by surgery (open/laparoscopic). Mortality is nil but morbidity is more for open procedures.Conclusions: There can be no definite algorithm for the management of CBD stones as the patients’ age, underlying general condition being the only standardizable factor with facilities for endoscopic, laparoscopic management being variably available from institution to institution and hence, necessitating tailoring the management of CBD stones depending upon the Institution’s resources.

scholarly journals P-BN39 The perils of MRCP requesting and early associations of data quality and likelihood of a diagnostic result

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Callum Jones ◽  
Helena Barton ◽  
Samir Pathak ◽  
Jonathan Rees
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Expectant Management ◽  
Clinical Information ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Cbd Stones ◽  
Optimal Information ◽  
Cbd Stone

Abstract Background MRCP (Magnetic resonance cholangiopancreatography) is used most to assess the biliary tree for stones or strictures. Recently, MRCP availability has increased, and it is extensively used to detect of common bile duct (CBD)stones although very frequently no stones are seen. Indeed, the currently recruiting sunflower RCT aims to determine the clinical and cost effectiveness of expectant management versus MRCP in patients undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. However, it is critical when requesting an investigation that adequate information is provided.  This work aimed, to describe the adequacy of information provided and correlate this with the MRCP result. We hypothesised that the less information that was provided the more common a normal result would be. Methods For a three month period (January 2021 to April 2021) all MRCP requests to detect the presence of a CBD stone were reviewed and data obtained from the Radiology CRIS (CDN Radiology Information System, CDN, Sydney, Aus.). The requesting information was compared to three pre-defined criteria (CBD diameter, presence of gallstones and LFT details) that were agreed as the optimal information that a reporting radiologist would require. The number of key pieces of information for each request and whether the request identified a CBD stone were identified. The proportion of MRCPs detecting a CBD stone was calculated according to the number of key pieces of information provided.     Results 56 patients were identified, of which 16 (29%) patients had CBD stones. In 24/56 (43%) patients the presence of gallstones on a previous ultrasound was provided, 14/56 (25%) of patients had information about LFTs including bilirubin and a trend in LFTs was not stated for any patient (0/56; 0%).  The rate of stone detection was calculated by the number of pieces of information provided. The rate was 71% (5/7) when all 3 pieces of data were provided, 31% (2/13) when two piece of information were provided, 30% (8/27) when a single piece of information was provided, and only 11% (1/11) when none of the specified data were provided. Conclusions It is uncommon for adequate clinical information to be provided in MRCP requests and in 16% of request no key information was provided. The LFT results were frequently omitted and the trend in LFTs never stated. The more key data provided in the request saw a higher proportion of MRCPs where a CBD stone was identified. We recommend that maximal clinical information is mandated for MRCP request perhaps using mandatory fields on electronic requesting systems and that  these systems are also used to facilitate recruitment to clinical trials such the Sunflower RCT.

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 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 Surgical procedure for unexpected balloon burst complication during endoscopic balloon dilatation in a patient with common bile duct stones

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koji Morishita ◽  
Hideaki Sasaki
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilatation ◽  
Rare Complication ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Balloon Dilatation ◽  
Cbd Stones ◽  
Endoscopic Balloon

Abstract Background Endoscopic balloon dilatation (EBD) is the established treatment for common bile duct (CBD) stones. Although pancreatitis and bleeding have been reported as major complications of EBD, balloon-related complications are rarely reported in EBD. Case presentation A 30-year-old woman with suspected CBD stones underwent endoscopic retrograde cholangiopancreatography (ERCP) and EBD. During EBD, the balloon of the EBD catheter suddenly burst at the biliary sphincter. We therefore performed surgical intervention: removal of the broken EBD catheter and T-tube drainage. Finally, the patient was discharged without any complications. Conclusions We present a case involving a burst balloon of an EBD catheter as a rare complication during EBD, as well as the surgical technique that was used to treat this complication.

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 Accuracy of Ultrasound and Magnetic Resonance Cholangiopancreatography Findings in the Diagnosis of Biliary System Stones

2022 ◽  
Vol 30 (1) ◽  
pp. 841-852
Author(s):  
Abdullah Taher Naji ◽  
Ameen Mohsen Amer ◽  
Saddam Mohammed Alzofi ◽  
Esmail Abdu Ali ◽  
Noman Qaid Alnaggar
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Final Diagnosis ◽  
Biliary System ◽  
Cbd Stones ◽  
System Diagnosis ◽  
Us Findings

This study aimed to evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and Ultrasound (US) images for the diagnosis of biliary system stones, as well as to assess the consistency between MRCP and US findings. The study sample included 200 cases (90 males and 110 females) with symptomatic biliary system stones between 14 and 82 years. All cases underwent both the US and MRCP imaging for biliary system diagnosis. The study revealed that the most prominent age group with symptoms of biliary system stones was the 33-60-year-old group. It also found that the accuracy of US and MRCP in detecting gallbladder (GB) stones compared with the final diagnosis was 94% and 91%, respectively, with moderate conformity between their results. The accuracy of US and MRCP images in detecting common bile duct (CBD) stones was 61% and 98%, respectively, with fair conformity between their results. In addition, there is a significant agreement between the MRCP and US results in detecting the GB and CBD stones with an agreed percentage of 74% and 71%, respectively. The study concluded that US is the preferred imaging technique for patients with symptomatic gallbladder stones, whereas MRCP is a trustworthy investigation for common bile duct stones.

scholarly journals Pre-operative MRCP: is it necessary before routine laparoscopic cholecystectomy to exclude CBD stone-prospective study in tertiary care hospital

2017 ◽  
Vol 4 (11) ◽  
pp. 3633 ◽  
Author(s):  
Ganni Bhaskara Rao ◽  
Samir Ranjan Nayak ◽  
Sepuri Bala Ravi Teja ◽  
Reshma Palacharla
Keyword(s):  
Patient Safety ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Liver Function Test ◽  
Ultrasound Examination ◽  
Cbd Stones ◽  
Function Test ◽  
Cbd Stone

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

scholarly journals Safety and efficacy of extracorporeal shock wave lithotripsy for difficult-to-retrieve common bile duct stones: A ten-year experience

2020 ◽  
Vol 8 (3) ◽  
pp. 159-164
Author(s):  
Muhammad Manzoor ul Haque ◽  
Nasir Hassan Luck ◽  
Abbas Ali Tasneem ◽  
Syed Mudassir Laeeq ◽  
Rajesh Mandhwani ◽  
...  
Keyword(s):  
Shock Wave ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extracorporeal Shock Wave Lithotripsy ◽  
Shock Wave Lithotripsy ◽  
Common Bile Duct Stones ◽  
Biliary Stones ◽  
Cbd Stones ◽  
Electrohydraulic Lithotripsy ◽  
Extracorporeal Shock Wave

AbstractBackground and ObjectiveExtracorporeal shock wave lithotripsy (ESWL) for common bile duct (CBD) stones has been used in the past, but experience is limited. We report our experience of ESWL in the management of difficult CBD stones.MethodsPatients with difficult-to-retrieve CBD stones were enrolled and underwent ESWL. Fluoroscopy is used to target the stones after injection of contrast via nasobiliary drain. CBD clearance was the main outcome of the study.ResultsEighty-three patients were included (mean age 50.5 ± 14.5 years); these patients were mainly females (43; 51.8%). Large stones >15 mm were noted in 64 (77.1%), CBD stricture in 22 (26.5%) and incarcerated stone in 8 (9.6%) patients. Patients needed 2.1 ± 1.2 sessions of lithotripsy and 4266 ± 1881 shock waves per session. In 75 (90.3%) patients, the fragments were extracted endoscopically after ESWL, while spontaneous passage was observed in 8 (9.6%). Total CBD clearance was achieved in 67 (80.6%) patients, partial clearance in 5 (6%) and no response in 11 (13.2%). Failure of the treatment was observed in large stone with size ≥2 cm (P = 0.021), incarcerated stone (P = 0.020) and pre–endoscopic retrograde cholangiopancreatography cholangitis (P = 0.047).ConclusionESWL is a noninvasive, safe and effective therapeutic alternative to electrohydraulic lithotripsy and surgical exploration for difficult biliary 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.

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