LAPAROSCOPIC MANAGEMENT OF COMMON BILE DUCT STONES

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.

Download Full-text

Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones

10.53350/pjmhs211561321 ◽

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,

Download Full-text

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

Gastroenterology Research and Practice ◽

10.1155/2009/840208 ◽

2009 ◽

Vol 2009 ◽

pp. 1-12 ◽

Cited By ~ 36

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.

Download Full-text

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

International Surgery Journal ◽

10.18203/2349-2902.isj20193306 ◽

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.

Download Full-text

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis

Internal Medicine ◽

10.2169/internalmedicine.9123-17 ◽

2018 ◽

Vol 57 (4) ◽

pp. 469-477 ◽

Cited By ~ 5

Author(s):

Hirokazu Saito ◽

Yoshihiro Kadono ◽

Kentaro Kamikawa ◽

Atsushi Urata ◽

Haruo Imamura ◽

...

Keyword(s):

Bile Duct ◽

Propensity Score ◽

Common Bile Duct ◽

Propensity Score Analysis ◽

Common Bile Duct Stones ◽

Single Stage ◽

Bile Duct Stones ◽

Stone Removal ◽

Score Analysis ◽

Endoscopic Stone Removal

Download Full-text

Abordaje laparoscópico sistemático de la coledocolitiasis

Revista Argentina de Cirugía ◽

10.25132/raac.v113.n1.1501.ei ◽

2021 ◽

Vol 113 (1) ◽

pp. 62-72

Author(s):

Carlos M. Canullán ◽

◽

Enrique J. Petracchi ◽

Nicolás Baglietto ◽

Hugo I. Zandalazini ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Bile Duct ◽

Common Bile Duct ◽

Preoperative Diagnosis ◽

Length Of Hospital Stay ◽

Common Bile Duct Stones ◽

Single Stage ◽

Bile Duct Stones ◽

Bile Duct Injuries ◽

Transcystic Approach

Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.

Download Full-text