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.

scholarly journals Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and Stone Extraction in 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 ◽  
Stone Extraction ◽  
Randomized Controlled Studies ◽  
The Mean ◽  
Cbd Exploration

Abstract Background: Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). For this purpose, we modified the surgical modality, exploring the use of laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, we can use this technique to resolve patients with secondary common bile duct stones, and the effect is better than placing T tubes.Methods: Sixty-eight patients were randomly offered the new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.Results: Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 minutes, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n=2) or Mirizze syndrome (n=1); LCBDE was performed in 3 patients due to cystic duct atresia (n=2) and low level of flow from the gallbladder duct into the CBD (n=1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) one year later.Conclusions: 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 complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

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

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation 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):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation 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):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

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

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
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 ◽  
Common Bile Duct Exploration ◽  
Stone Extraction

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 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.

Cystic duct dilation during laparoscopic transcystic common bile duct exploration

1998 ◽  
Vol 187 (4) ◽  
pp. 461-463 ◽  
Author(s):  
Yoichi Ishizaki ◽  
Yasushi Takeda ◽  
Toru Miyahara
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration

Two-Port Laparoscopic Common Bile Duct Exploration with T-tube Choledochostomy for Management of Choledocholithiasis: An Initial Clinical Report

2011 ◽  
Vol 77 (4) ◽  
pp. 422-425
Author(s):  
Ding-Ping Sun ◽  
Wen-Ching Wang ◽  
Kuo-Chang Wen ◽  
Kai-Yuan Lin ◽  
Yi-Feng Lin ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Standard Procedure ◽  
Abdominal Cavity ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Tube Placement ◽  
Clinical Report ◽  
T Tube ◽  
Cbd Stones

Laparoscopic common bile duct exploration (LCBDE) is generally performed using a four- or five-port technique. We report a unique technique of two-port transcholedochal LCBDE with T-tube placement. Twelve consecutive patients with common bile duct (CBD) stones underwent LCBDE through two entry ports, one homemade single port (Uen port) inserted in a 2-cm umbilical wound and one 5-mm subxiphoid trocar port. With the assistance of a 1.2-mm needle that was inserted through a right lower intercostal space into the abdominal cavity to facilitate the operation, two-port dome-down laparoscopic cholecystectomy, choledochotomy, choledochoscopic removal of ductal caculi, and T-tube choldochostomy were performed with conventional methods using standard laparoscopic instruments along with manually operated angled shafts. After completion of the operation, the T-tube catheter was brought out through the subxiphoid trocar wound. All operations were completed successfully without the need of additional ports. There was no complication and no residual stones. Mean operation time was 120 minutes (range, 90 to 150 minutes), and mean postoperative hospital stay was 3.5 days (range, 3 to 4 days). Scarless wound healing was achieved except one T-tube scar. Two-port transumbilical LCBDE with T-tube choledochostomy is a feasible, safe, and effective technique that allows one-scar abdominal surgery for treatment of CBD stones. Further studies and the development of better instruments are necessary before this can be recommended as a standard procedure.

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