Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass

Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.

Complications of laparoscopic choledochotomy and lithotomy for primary suture

Objective: To explore the non-placement of "T" tube" after laparoscopic choledochotomy. feasibility and complication analysis of primary suture bile duct. Methods: Retrospective analysis of January 2013~ December 2016, Laparoscopic choledocholithotomy for primary bile duct suture in 87 cases, Combined with literature, the indications, methods and complications of the operation were summarized and analyzed. Results: There was no operative death in the whole group, Postoperative complications occurred in 5 cases (5.7%), 1 case with jaundice, gradually subsided after 4 days of conservative treatment. Two cases had postoperative bile leakage, to prolong the drainage time of the peritoneal drainage tube and stop by itself. In 1 case, bile duct stenosis occurred. 1 case of residual common bile duct stones. The average postoperative hospitalization was 9 days. Conclusion: Select the right case strictly, Patient and delicate operation, Laparoscopic choledochotomy is safe and feasible.

Results of laparoscopic for the management of bile duct stones

Introduction: To describe clinical and para-clinical characteristics of bile duct stones and results of laparoscopic choledochotomies in management of bile duct stones. Materials and methods: Retrospective and prospective study in 152 bile duct stones patient, who underwent laparoscopic choledochotomy with or without usage of flexible bile ducts scope and electrohydraulic technique, from January 2009 to May 2019 at Hue Central Hospital. Results: Mean age 54,2 (22 - 84), 66 male and 86 female, mean operative time: 135 minutes (90 - 235), intraoperative complications: 3,29%, open conversion: 5,92%. Complete stone clearance was achieved in 91,6% patients. Postoperative complications: 7,69%. Conclusions: Managementofbileductstonesbylaparoscopiccholedochotomy is safe and effective with high percentage of stones clearence, as well as low intraoperative and postoperative complications. This procedure can achieve good results if bile ducts scope and electrohydraulic technique were concomitantly applied.

Analysis of 87 cases of laparoscopic choledochotomy with primary suture

To investigate the feasibility and clinical effect of laparoscopic choledochotomy for primary suture of bile duct. Methods: There were 190 cases of cholecystolithiasis with choledocholithiasis. They were randomly divided into endoscopic group and open group. In the endoscopic group ,87 patients underwent laparoscopic choledocholithotomy and primary bile duct suture. A total of 103 patients in open group were treated with open bile duct incision and T tube drainage. The operative time, intraoperative blood loss, postoperative ventilation time, hospital stay and postoperative complications were compared between the two groups. Results: The length of hospital stay, the amount of bleeding during operation and the time of postoperative ventilation were less than those in open group. The operation time was longer than that in open group, P <0.01. There were 0 cases of postoperative incision infection ,2 cases of bile leakage and 1 case of residual stone in endoscopic group. The incidence of complications was 5.7%. The open group was 5,3,3 and 10.7% respectively. Comparison of complications between the two groups, P<0.01. Conclusion: Select the right case strictly, Laparoscopic and choledochoscopy combined with cholecystolithiasis with choledocholithiasis is effective, safe and minimally invasive, short hospitalization time and less complications.

The effect of the laparoscopic primary suture of the common bile duct in elderly patients: a retrospective study

Background Traditionally, Surgical treatment strategies for elderly patients diagnosed with choledocholithiasis combined with cholecystolithiasis include laparoscopic choledocholithotomy, cholecystectomy, and T-tube drainage. However, T-tube drainage in the biliary tract can still cause pain and other complications. This study was designed to compare the primary closure of choledochotomy and the use of T-tube after laparoscopic choledochotomy to determine whether primary suture can be as feasible and safe as suture with T-tube drainage in elderly patients. Methods From January 2017 to January 2018, 85 patients were selected to undergo laparoscopic surgery. They were divided into two groups: primary suture group (n=56) and T tube group (n=29). Preoperative data, intraoperative index, postoperative complications were recorded. Results There were no differences in preoperative data in both groups. Compared with the T-tube group, the postoperative total drainage volume on the first day and patients of residual stones were fewer, and all drainage tube extubation time was shorter in the primary suture group. And there were statistically significant differences in postoperative TBIL between the two groups. There were no pressure sores, hypostatic pneumonia, deep vein thrombosis, serious complications of heart, lung and brain and even death in both groups. Conclusion Only if accurate preoperative risk assessment and strict treatment of basic diseases in elderly patients, intraoperative fine suture of the common bile duct, primary suture in elderly patients are feasible, safe, and valid after laparoscopic choledochotomy for verification of ductal clearance.