Laparoscopic common bile duct exploration associating with electrohydraulic lithotripsy via choledochoscopy in Vietnam – Thuy Dien - Uong Bi Hospital

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Case Series ◽  
Common Bile Duct Exploration ◽  
Biliary Stones ◽  
Average Hospital ◽  
Intrahepatic Stones ◽  
Electrohydraulic Lithotripsy ◽  
Case Series Study ◽  
Duration Of Surgery

Tóm tắt Đặt vấn đề: Sỏi đường mật chính thường gặp là ống mật chủ (OMC) là bệnh lý phổ biến ở Việt Nam. Phẫu thuật nội soi (PTSN) để lấy sỏi qua OMC ngày càng được áp dụng rộng rãi trong điều trị bệnh sỏi mật. Kết hợp tán sỏi qua nội soi đường mật trong lúc phẫu thuật nhằm làm sạch sỏi đặc biệt là sỏi trên gan đang được áp dụng ở nhiều cơ sở. Phương pháp nghiên cứu: Nghiên cứu kết quả ứng dụng PTNS và nội soi tán sỏi qua OMC để điều trị sỏi đường mật chính tại bệnh viện VN-TĐ Uông Bí. Phương pháp can thiệp lâm sàng, mô tả tiến cứu. Đối tượng nghiên cứu là những người bệnh có sỏi đường mật chính (sỏi đường mật trong gan và ngoài gan) được PTNS ổ bụng lấy sỏi đường mật qua OMC có kết hợp tán sỏi điện thủy lực được thực hiện tại bệnh viện VN-TĐ Uông Bí từ 9/2014-9/2017. Thông tin của người bệnh được thu thập trước và sau phẫu thuật, xử lý bằng phần mềm thống kê y học SPSS 16.1. Kết quả: Gồm 31 trường hợp (TH) được nghiên cứu, có 9 nam và 22 nữ, tuổi trung bình là 55,45 ± 15,05. Trong đó sỏi OMC đồng thời với sỏi trong gan là 31, sỏi túi mật kết hợp 9 TH. 21 TH lấy hết sỏi đường mật ngay trong phẫu thuật. 10 người bệnh còn sót sỏi trong gan phải lấy sỏi qua đường hầm Kehr sau 1 tháng. 1 người bệnh phải chuyển mổ mở, 2 người bệnh bị rò mật sau mổ. Thời gian phẫu thuật trung bình là 130.65 ± 46.91 phút, thời gian nằm viện trung bình là 8,58 ± 3,59 ngày. Không có tử vong do phẫu thuật. Kết luận: Đây là những kinh nghiệm PTNS mở OMC có kết hợp với nội soi tán sỏi để điều trị sỏi đường mật đầu tiên của chúng tôi. Chúng tôi nhận thấy phẫu thuật có tính khả thi an toàn cũng như hiệu quả tại bệnh viện VN-TĐ Uông Bí. Abstract Introduction: Common bile duct (CBD) stone is endemic in Vietnam. Laparoscopic common bile duct exploration (LCBDE) has gained wide popularity in the treatment of choledocholithiasis. At the same time, electrohydraulic lithotripsy (EHL) via choledochoscopy might help to clear intrahepatic stones. Material and Methods: The aim of this study is to access the results of laparoscopic common bile duct exploration associating with electrohydraulic lithotripsy via choledochoscopy to clear biliary stones Vietnam – Thuy Dien – Uong Bi Hospital. This is a prospective, interventional and descriptive case series study. Patients with both extra-and intra-hepatic stones who underwent laparoscopic common bile duct exploration (LCBDE) from September 2014 to September 2017 were enrolled in our study. The data was prospectively collected and analysed by using SPSS 16.1. Results: There were 9 men and 22 women with age ranging from 12 to 78 years old (average 55,45 ± 3,59). There were 9 patients with gallbladder stones. Complete bile duct clearance was done in 21 patients. 10 patients with residual intrahepatic stones required extracting stones through T tube tunnel by choledochoscopy and EHL. The average duration of surgery was 130.65 ± 46.91 minutes and the average hospital stay was 8,55 ± 3,59 days. There were one conversion to open surgery and two cases of bile leakage. We had non-fatal postoperative complications. Conclusion: This is preliminary experience of LCBDE in my hospital in the management of choledocholithiasis. It should be considered effective and feasible in the treatment of CBD stones in Vietnam – Thuy Dien – Uong Bi Hospital. Keyword: Laparoscopic common bile duct exploration, Electrohydraulic lithotripsy via choledochoscopy

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.

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 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.

Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients.

Radiology ◽  
1991 ◽  
Vol 180 (2) ◽  
pp. 345-348 ◽  
Author(s):  
D H Bonnel ◽  
C E Liguory ◽  
F E Cornud ◽  
J F Lefebvre
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Intrahepatic Stones ◽  
Electrohydraulic Lithotripsy

Partial Cholecystectomy as a Safe and Viable Option in the Emergency Treatment of Complex Acute Cholecystitis: A Case Series and Review of the Literature

2007 ◽  
Vol 73 (5) ◽  
pp. 498-507 ◽  
Author(s):  
Mehrdad Soleimani ◽  
Arianeb Mehrabi ◽  
Zhoobin A. Mood ◽  
Hamidreza Fonouni ◽  
Arash Kashfi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Case Series ◽  
Common Bile Duct Stones ◽  
Common Bile Duct Exploration ◽  
Biliary Fistula ◽  
Safe Procedure ◽  
Review Of The Literature ◽  
Increased Risk

Partial cholecystectomy (PC) is an alternative choice to standard cholecystectomy in situations with increased risk of Calot's components injury. We reported our experience with the patients treated with PC and reviewed the literature. Fifty-four patients with complex acute cholecystitis underwent PC, including conventional partial cholecystectomy (CPC; n = 48) and laparoscopic partial cholecystectomy (LPC; n = 6). The clinical diagnosis was verified by ultrasonography. In addition, we reviewed 1190 published cases (1972–2005) who underwent a “nonconventional” surgery for severe cholecystitis, including cholecystostomy, CPC, or LPC. Review of the literature, including our cases, showed a male:female ratio of 1.3:1. The major operative indication was severe acute cholecystitis. Procedures included cholecystostomy (65.8%) and PC (34.2%). In the follow-up (n = 1190), biliary leak (4.8%), retained stones (4.6%), recurrent symptoms (2.3%), wound infections (1.9%), persistent biliary fistula (0.9%), and prolonged biliary drainage (0.2%) were found, with an overall mortality rate of 9.4 per cent. In 133 patients, because of postoperative complications ( e.g., recurrent symptoms, remaining common bile duct stones, or persistence of bile fistula), reoperation was necessary, including 121 cases (90.1%) of cholecystectomy, whereas the other 11 patients underwent other procedures such as common bile duct exploration or closure of the fistula. The surgical trend for complex acute cholecystitis treatment has been changed from only cholecystostomy to a spectrum of cholecystostomy, CPC, and LPC with the progressive increase of PC. The proportion of the LPC compared with CPC has also increased during recent years. It seems that PC is a safe procedure for treating complicated acute cholecystitis. Whether the indication and need for alternative techniques to standard cholecystectomy is changing should be evaluated in future studies.

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