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Nassar AHM, Qandeel H, Khan KS, Ng HJ, Hasanat S, Ashour H. The "Basket-in-Catheter" technique: facilitating transcystic bile duct exploration and optimising the management of suspected ductal stones. Updates Surg 2023; 75:1893-1902. [PMID: 37537316 DOI: 10.1007/s13304-023-01610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
The 'Basket-in-Catheter' (BIC) technique facilitates basket-only laparoscopic transcystic exploration (LTCE), increasing its success rate. Using the cholangiography catheter as a sheath is easier and safer than inserting the wire basket-alone. This study evaluates its benefits in confirmed and suspected ductal stones. Retrospective analysis of prospectively collected data on patients with pre-operative or operative suspicion of bile duct stones or with positive and equivocal intraoperative cholangiographies (IOC) who had LTCE attempted using blind basket trawling, without choledochoscopy, were reviewed. The incidence and outcomes of blind basket LTCEs attempted before and after introducing the BIC technique, whether or not stones were retrieved, were analysed. Blind basket LTCE was attempted in 732 patients. Of 377 (51.5%) patients undergoing successful stone retrieval, only 62% had pre-operative clinical and radiological risk factors for ductal stones, 25% had operative risk factors and 13% had silent stones discovered on IOC. Another 355 patients (48.5%) had negative trawling, although one half had pre-operative risk factors for ductal stones and 47.6% had operative risk factors, e.g. cystic duct stones or dilatation. This cohort had equivocal cholangiography in 25.9%. Following basket trawling, repeat IOC confirmed resolution of abnormalities. As no stones were retrieved, these were not considered duct explorations. The BIC technique facilitates safe and speedy bile duct clearance when stones are confirmed, avoiding choledochotomies, without significant complications. BIC duct trawling is also beneficial in patients with suspected ductal stones, helping to resolve equivocal IOCs. It helps surgeons to acquire and consolidate ductal exploration skills.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK.
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland.
| | - Haitham Qandeel
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
| | - Khurram S Khan
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland
- University Hospital Hairmyres, Lanarkshire, Scotland, UK
| | - Hwei J Ng
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- Royal Alexandra Hospital, Paisley, Scotland, UK
| | - Subreen Hasanat
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
| | - Haneen Ashour
- Laparoscopic Biliary Service, University Hospital Monklands, Lanarkshire, Scotland, UK
- The Hashemite University, Zarqa, Jordan
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Chiu BY, Chuang SH, Chuang SC, Kuo KK. Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review. World J Clin Cases 2023; 11:1939-1950. [PMID: 36998949 PMCID: PMC10044958 DOI: 10.12998/wjcc.v11.i9.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.
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Affiliation(s)
- Bo-Ya Chiu
- School of Post-baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Utilization of Laparoscopic Choledochoscopy During Bile Duct Exploration and Evaluation of the Wiper Blade Maneuver for Transcystic Intrahepatic Access. Ann Surg 2023; 277:e376-e383. [PMID: 33856382 PMCID: PMC9831050 DOI: 10.1097/sla.0000000000004912] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy. SUMMARY OF BACKGROUND DATA Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic exploration. METHODS The indications, techniques, and operative and postoperative data on choledochoscopy collected prospectively during transcystic and choledo- chotomy explorations were analyzed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochoscopes. RESULTS Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during 1320 bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilized more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts, and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. Twenty retained stones (2.1%) were encountered but no choledochoscopy related complications. CONCLUSIONS Choledochoscopy should always be performed during a chol- edochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilized in over 50% of explorations, increasing their rate of success. When attempted, the transcystic WBM achieves intrahepatic access in 70%-80%. It should be part of the training curriculum.
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Lei C, Lu T, Yang W, Yang M, Tian H, Song S, Gong S, Yang J, Jiang W, Yang K, Guo T. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc 2021; 35:5918-5935. [PMID: 34312727 DOI: 10.1007/s00464-021-08648-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides better outcomes for patients with gallstones and common bile duct stones. METHODS Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to identify eligible articles from the database inception to September 2020. The revised Cochrane risk of bias tools for randomized trials (RoB-2) and non-randomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The primary outcomes consisted of surgical success, retained stones, and overall postoperative complications, while secondary outcomes included postoperative bleeding, postoperative pancreatitis, postoperative bile leakage, conversion to laparotomy, and operative time. RESULTS Eight studies (four RCTs and four Non-RCTs with high quality) with 2948 patients were included. No significant difference was seen between the two groups regarding surgical success, overall postoperative complications, conversion to laparotomy, and operative time. The meta-analysis demonstrated that in the LC-IntraERCP group, the rate of retained stones (OR 0.51, 95% CI 0.28-0.91) and postoperative bile leakage were lower (OR 0.25, 95% CI 0.09-0.69), while in the LC-LCBDE group, postoperative bleeding (OR 5.24, 95% CI 1.65-16.65) and postoperative pancreatitis (OR 4.80, 95% CI 2.35-9.78) decreased. CONCLUSIONS LC-IntraERCP and LC-LCBDE exhibited similar efficacies when surgical success rate, overall postoperative complications, conversion to laparotomy, and operative time were compared. However, LC-IntraERCP is probably to be more effective in terms of lowering the rate of retained stones.
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Affiliation(s)
- Caining Lei
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenwen Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Man Yang
- The Affiliated Cancer Hosptial School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China
| | - Shaoming Song
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenjie Jiang
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China. .,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Tiankang Guo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China. .,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China. .,Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China.
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Alvarez chica LF, Rico-Juri JM, Carrero-Rivera SA, Castro-Villegas F. Coledocolitiasis y exploración laparoscópica de la vía biliar. Un estudio de cohorte. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La coledocolitiasis es la presencia de cálculos en las vías biliares. En la mayoría de los casos se trata mediante la colangio pancreatografía retrógrada endoscópica y menos comúnmente por intervención quirúrgica laparoscópica. El objetivo de este estudio fue describir una cohorte retrospectiva de pacientes sometidos a exploración laparoscópica de la vía biliar.
Métodos. Se incluyeron pacientes intervenidos entre los años 2014 y 2018, en dos instituciones de nivel III en Cali, Colombia, referidos para valoración por cirugía hepato-biliar, por dificultad para la extracción de los cálculos por colangio pancreatografia retrograda endoscópica, debido al tamaño, la cantidad, o la dificultad para identificar o canular la papila duodenal.
Resultados. De los 100 pacientes incluidos, se encontró que el 72 % fueron mujeres, con rango de edad entre 14 y 92 años. Al 39 % de los pacientes se les extrajo un solo cálculo y al 16 % 10 cálculos. Un 12 % presentaron cálculos gigantes (mayores de 2,5 cm de ancho) y un 44 % presentaron litiasis múltiple. Al 69 % de los pacientes se les realizó colecistectomía. El porcentaje de éxito de limpieza de la vía biliar por laparoscopia fue del 95 %.
Discusión. La exploración laparoscópica de la vía biliar es una técnica posible, reproducible, segura y con excelentes resultados para el manejo de la coledocolitiasis.
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Nassar AHM, Ng HJ, Ahmed Z, Wysocki AP, Wood C, Abdellatif A. Optimising the outcomes of index admission laparoscopic cholecystectomy and bile duct exploration for biliary emergencies: a service model. Surg Endosc 2020; 35:4192-4199. [PMID: 32860135 PMCID: PMC8263394 DOI: 10.1007/s00464-020-07900-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023]
Abstract
Aims The rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with referral protocols, refined logistics and targeted job planning. Methods A prospectively maintained dataset was evaluated to determine the processes of care and outcomes of patients undergoing emergency biliary surgery. The lead author has maintained a 28 years prospective database capturing standard demographic data, intraoperative details including the difficulty of cholecystectomy as well as postoperative outcome parameters and follow up data. Results Over five thousand (5555) consecutive laparoscopic cholecystectomies were performed. Only patients undergoing emergency procedures (2399,43.2% of entire group) were analysed for this study. The median age was 52 years with 70% being female. The majority were admitted with biliary pain (34%), obstructive jaundice (26%) and acute cholecystitis (16%). 63% were referred by other surgeons. 80% underwent surgery within 5 days (40% within 24 h). Cholecystectomies were performed on scheduled lists (44%) or dedicated emergency lists (29%). Two thirds had suspected bile duct stones and 38.1% underwent bile duct exploration. The median operating time was 75 min, median hospital stay 7 days, conversion rate 0.8%, morbidity 8.9% and mortality rate 0.2%. Conclusion Index admission cholecystectomy for biliary emergencies can have low rates of morbidity and mortality. Timely referral and flexible theatre lists facilitate the service, optimising clinical results, number of biliary episodes, hospital stay and presentation to resolution intervals. Cost benefits and reduced interval readmissions need to be weighed against the length of hospital stay per episode.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK.
| | - Hwei J Ng
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Colin Wood
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Ayman Abdellatif
- Laparoscopic Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK
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Navaratne L, Martinez Isla A. Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases. Surg Endosc 2020; 35:437-448. [PMID: 32246237 DOI: 10.1007/s00464-020-07522-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many studies have failed to demonstrate significant differences between single- and two-staged approaches for the management of choledocholithiasis with concomitant gallstones in terms of post-operative morbidity. However, none of these studies paid specific attention to the differences between the methods of accessing the bile duct during laparoscopy. The aim of this study was to report outcomes of transcystic versus transductal laparoscopic common bile duct exploration (LCBDE) from our experience of over four hundred cases. METHODS Retrospective review of 416 consecutive patients who underwent LCBDE at a single-centre between 1998 and 2018 was performed. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, intra-operative findings (including negative choledochoscopy rates, use of holmium laser lithotripsy and operative time) and post-operative outcomes. RESULTS Transductal LCBDE via choledochotomy was achieved in 242 patients (58.2%), whereas 174 patients (41.8%) underwent transcystic LCBDE. Stone clearance rates, conversion to open surgery and mortality were similar between the two groups. Overall morbidity as well as minor and major post-operative complications were significantly higher in the transductal group. The main surgery-related complications were bile leak (5.8% vs 1.1%, p = 0.0181) and pancreatitis (7.4% vs 0.6%, p = 0.0005). Median length of post-operative stay was also significantly greater in the transductal group. CONCLUSION This study represents the largest single study to date comparing outcomes from transcystic and transductal LCBDE. Where possibly, the transcystic route should be used for LCBDE and this approach can be augmented with various techniques to increase successful stone clearance and reduce the need for choledochotomy.
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Affiliation(s)
- Lalin Navaratne
- Department of Upper GI Surgery, Northwick Park Hospital & St Mark's Hospital, Watford Road, London, HA1 3UJ, UK.
| | - Alberto Martinez Isla
- Department of Upper GI Surgery, Northwick Park Hospital & St Mark's Hospital, Watford Road, London, HA1 3UJ, UK
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Jabbar SAA, Ahmed Z, Mirza A, Nassar AHM. Laparoscopic Training Opportunities in an Emergency Biliary Service. JSLS 2019; 23:JSLS.2019.00031. [PMID: 31488943 PMCID: PMC6708413 DOI: 10.4293/jsls.2019.00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Optimizing single-session management of biliary emergencies whilst maximizing laparoscopic training opportunities is challenging. We analyzed training opportunities available in an emergency biliary department and its impact on service provision and patient outcomes. Methods: A single surgeon's practice of 2049 emergency laparoscopic cholecystectomies and common bile duct explorations was prospectively analyzed. Training involved a modular stepwise approach incorporating access, gallbladder bed dissection, pedicle dissection, intra- corporeal tying, and cholangiogram ± common bile duct exploration. Training cases were identified, trainee involvement ascertained, and parameters predictive of a training case were established. Results: Thirty percent of laparoscopic cholecystectomies were performed in part or completely by trainees, with a training component in 30% of bile duct explorations. Trainee involvement increased mean operating time by approximately 10 minutes. There was no difference in minor (5% vs 5%, P = .8) or major complications (1% vs 0.9%, P = .7) on trainee versus consultant cases. Postoperative hospital stay was greater in consultant cases (2.87 vs 4.44 days, P = .0025). Multivariate analysis identified predictors of trainee cases including lower age (OR, 1.3; 95% CI, 1.1-1.7), female sex (OR, 1.6; 95% CI, 1.3-2), normal-weight subjects (OR, 1.54; 95% CI, 1.3-1.9), lower difficulty grade (1-2) (OR, 1.8; 95% CI, 1.4-2.2), and American Society of Anesthesiologists score ≤ 2 (OR, 1.8; 95% CI, 1.4-2.4). Conclusions: Surgical training is possible in a singlesession biliary emergency service without significantly impacting theatre utilization times or early patient outcomes. Further dedicated studies will allow individual learning curves to be determined.
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Affiliation(s)
- Salman A A Jabbar
- Department of General Surgery, University Hospital Monklands, Airdrie, Lanarkshire, United Kingdom
| | - Zubir Ahmed
- Department of General Surgery, University Hospital Monklands, Airdrie, Lanarkshire, United Kingdom
| | - Ahmad Mirza
- Department of General Surgery, University Hospital Monklands, Airdrie, Lanarkshire, United Kingdom
| | - Ahmad H M Nassar
- Department of General Surgery, University Hospital Monklands, Airdrie, Lanarkshire, United Kingdom
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Ding GQ, Zhu JG, Wang D, Guo W, Zhang ZT. Five-year follow-up outcomes of laparoscopic choledochoscopy via the cystic duct for choledocholithiasis in patients with gallstones and common bile duct stones. Shijie Huaren Xiaohua Zazhi 2019; 27:756-760. [DOI: 10.11569/wcjd.v27.i12.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are many treatments for gallstones combined with common bile duct stones. Currently, laparoscopic cholecystectomy plus common bile duct exploration and endoscopic sphincterotomy plus laparoscopic cholecystectomy are often used, but T tube drainage is required for the former, and the latter is controversial due to the destruction of the Oddi sphincter.
AIM To investigate the clinical effect of laparoscopic choledochoscopy in the treatment of gallstones with common bile duct stones.
METHODS A total of 125 patients who underwent laparoscopic choledochoscopy and cholecystectomy for gallbladder stones and common bile duct stones were followed for 5 years from January to December 2013. The clinical effects were analyzed.
RESULTS The operation was successful in 122 cases, with a success rate of 97.6%. The average age of the patients was 58.21 ± 13.01 years old. The mean operation time was 87.95 ± 39.12 min, and mean intraoperative blood loss was 11.27 ± 6.85 mL. All patients underwent balloon dilatation, of whom 33 underwent microctomy at the confluence of the cystic duct and 5 underwent lithotrity via choledochoscopy. The mean time to first postoperative exhaust was 32.48 ± 17.85 h, and mean postoperative hospital stay was 2.03 ± 1.62 d. The rate of complications at short-term follow-up was 5.74%, and there were a total of 7 cases, including 4 cases of postoperative pancreatitis cured by symptomatic treatment with octreotide and ulinastatin, 2 cases of bile leakage cured by ENBD drainage, and 1 case of surgical wound infection cured by re-dresses. The rate of complications at 5-year follow-up was 4.92%, and there were 4 cases of recurrent common bile duct stones, including 1 case with intrahepatic bile duct stones and 2 cases with pancreatitis. Four patients died, of whom two patients had a myocardial infarction, one had a lung infection, and one had a car accident, all of which were not related to the operation.
CONCLUSION Laparoscopic choledochoscopy for the treatment of gallbladder stones combined with common bile duct stones has both good short- and long-term results, with the advantages of little trauma, rapid recovery, and few complications.
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Affiliation(s)
- Guo-Qian Ding
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Wei Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
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Navaratne L, Martinez-Isla A. 10 years of laparoscopic common bile duct exploration: A single tertiary institution experience. Am J Surg 2019; 219:642-644. [PMID: 31029285 DOI: 10.1016/j.amjsurg.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 01/21/2023]
Affiliation(s)
- L Navaratne
- Northwick Park & St Mark's Hospitals, Watford Road, Harrow, London, HA1 3UJ, UK.
| | - A Martinez-Isla
- Northwick Park & St Mark's Hospitals, Watford Road, Harrow, London, HA1 3UJ, UK
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Chuang SH, Hung MC, Huang SW, Chou DA, Wu HS. Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches. Surg Endosc 2018; 32:485-497. [PMID: 28643057 DOI: 10.1007/s00464-017-5658-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic surgery for choledocholithiasis is still evolving. Only a few reports of single-incision laparoscopic common bile duct exploration (LCBDE) have been published. METHODS One hundred and one consecutive patients underwent single-incision LCBDE (SILCBDE) by one surgeon with straight instruments during a 42-month period. RESULTS Choledochotomies were performed on 61 patients (60.4%). The success rate of intrahepatic duct exploration was 68.0% (17/25) for patients undergoing transcystic choledochoscopic bile duct explorations following longitudinal cystic ductotomies. The ductal clearance rate was 100%. Eighteen procedures (17.8%) were converted, including one open surgery. Nineteen patients (18.8%) experienced 26 episodes of complications; the majority (19 episodes) were classified as Clavien-Dindo grade I. Excluding those patients with Mirizzi syndrome (McSherry type II), multivariate logistic regressions showed that patients who were older or had complicated cholecystitis had higher procedure conversion rates and that higher modified APACHE II scores, higher white blood cell counts, and longer operative times were independent risk factors for complications. Based on operative times, 20 successful SILCBDEs were needed to get through the learning phase. A higher transcystic approach rate (46.5 vs. 8.3%; P < 0.01) and a shorter operative time (207 ± 62 vs. 259 ± 66 min; P < 0.01) were observed in the experienced phase. Compared with our early series of multi-incision LCBDE, the SILCBDE group had a higher bile duct stone clearance rate (100 vs. 94.4%; P < 0.05) and a higher proportion of patients with concomitant acute cholecystitis (59.6 vs. 22.2%; P < 0.01). CONCLUSIONS LCBDE with a 100% ductal clearance rate is possible following an algorithm for various approaches. SILCBDE is feasible under a low threshold for procedure conversion. A transcystic approach should be tried first if indicated, and a longitudinal cystic ductotomy to the cystocholedochal junction is beneficial. Prospective, randomized trials comparing single-incision and multi-incision LCBDE are anticipated.
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Affiliation(s)
- Shu-Hung Chuang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Min-Chang Hung
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Shih-Wei Huang
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
| | - Dev-Aur Chou
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan.
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan.
| | - Hurng-Sheng Wu
- Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan
- IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan
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Passage of Gallstones Into Common Bile Duct During Laparoscopic Cholecystectomy: Is It the Surgeon's Responsibility? Surg Laparosc Endosc Percutan Tech 2017; 27:110-112. [PMID: 28212261 DOI: 10.1097/sle.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Gallstones patients without preoperative history of jaundice, deranged liver function tests, or dilated bile ducts (BD) are unlikely to have BD stones. However, some of these patients in our series underwent endoscopic stone(s) removal after laparoscopic cholecystectomy (LC). We aim to find the incidence, possible intraoperative risk factors, and if the Surgeon can be blamed for this event. MATERIALS AND METHODS We studied LC cases over 12-year period at our university hospital and identified patients who did not have preoperative risk factors for BD stones but developed postoperative jaundice and/or persistent abdominal pain. RESULTS Only 16 (0.7%) of 2390 LC met the inclusion criteria. In 5/16 patients, cystic duct (CD) stones were felt Intraoperatively and likely passed into BD during surgery. After surgery, 14/16 patients underwent endoscopic stone(s) removal. CONCLUSIONS If CD stone(s) are encountered during LC, we suggest that careful attention should be paid to make sure that patient does not develop complications from possible BD stone(s). Technical precautions during LC (ie, early CD clipping, avoiding excessive manipulation, and crushing the stones) are recommended.
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