scholarly journals One-stage versus sequential endoscopic retrograde cholangio- pancreatography and laparoscopic cholecystectomy in patients with symptomatic gallstones and suspected common bile duct stones

2010 ◽  
Vol 7 (2) ◽  
pp. 105-110
Author(s):  
Mahmoud Bahram ◽  
Hatem Soltan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Stage Versus ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
One Stage ◽  
Symptomatic Gallstones

Positive Intraoperative Cholangiography during Laparoscopic Cholecystectomy: Is Laparoscopic Common Bile Duct Exploration Necessary?

2005 ◽  
Vol 71 (9) ◽  
pp. 750-753
Author(s):  
Gabriel Akopian ◽  
James Blitz ◽  
Thomas Vander Laan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Case Series ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Technical Problems ◽  
The Common

The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques.

scholarly journals Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct

2005 ◽  
Vol 42 (4) ◽  
pp. 239-243 ◽  
Author(s):  
Marcus Vinicius Silva Ney ◽  
Fauze Maluf-Filho ◽  
Paulo Sakai ◽  
Bruno Zilberstein ◽  
Joaquim Gama-Rodrigues ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Ultrasound ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde Cholangiography ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
The Common ◽  
Common Bile Duct Diameter

BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7%) had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67%) for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%). Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a group of patients with an intermediate or moderate risk with respect to the likelihood of having common bile duct stones, endoscopic ultrassonography is a better test for the diagnosis of choledocholithiasis when compared to endoscopic retrograde cholangiography mainly for small-sized calculi.

Hospital cost categories of one-stage versus two-stage management of common bile duct stones

2009 ◽  
Vol 24 (2) ◽  
pp. 413-416 ◽  
Author(s):  
B. Topal ◽  
K. Vromman ◽  
R. Aerts ◽  
C. Verslype ◽  
W. Van Steenbergen ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Cost ◽  
Common Bile Duct Stones ◽  
Stage Versus ◽  
Bile Duct Stones ◽  
Stage Management ◽  
Two Stage ◽  
One Stage ◽  
Cost Categories
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