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Al-Ardah M, Barnett RE, Whewell H, Boyce T, Rasheed A. Laparoscopic Common Bile Duct Clearance, is It Feasible and Safe After Failed Endoscopic Retrograde Cholangiopancreatography? J Laparoendosc Adv Surg Tech A 2023; 33:1-7. [PMID: 35704307 DOI: 10.1089/lap.2022.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Concomitant gallstones and common bile duct (CBD) stones is a common problem, and there is still no consensus on the best approach in the management. Options include preoperative endoscopic retrograde cholangiopancreatography (ERCP), Laparoscopic cholecystectomy (LC) with CBD exploration, and LC with postoperative ERCP. Each option has its own limitations and complications. In this article, we assessed the feasibility of laparoscopic surgical clearance of the CBD after a failed ERCP, reasons for failure of endoscopic clearance in our cohort. We will discuss the management options after ERCP failure, the challenges, and the outcomes. Materials and Methods: We retrospectively reviewed all the cases of laparoscopic common bile duct exploration (LCBDE) performed in our hospital between April 2006 and January 2019. Two hundred cases were performed, 178 cases as a primary procedure while 22 were performed as a secondary procedure after failed ERCP. We have previously published data on the case series (PMID 33140155) and here explored the cases performed after failed ERCP as a secondary procedure. We analyzed demographics of patients, preoperative investigations, ERCP trials, and reasons for ERCP failure, operative approach, duration of operation, conversion rate, complications, and outcomes. Results: Twenty-two patients underwent a laparoscopic CBD clearance after failed ERCP. Sixteen of these were in the first 5 years of the study. Multiple attempts of ERCP were made in 7 patients (31.8%) and a single attempt in 15 patients. In 8 patients (32%), the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had impacted stones larger than 1 cm, 4 patients had Mirrizi syndrome with concomitant large CBD stones, and 1 patient failed endoscopic clearance because of the large number of stones in the CBD. CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach. Postoperative length of stay was 12 (+10) days. One patient had an unplanned readmission within 30 days. One patient required reoperation for bleeding. Three patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded. Conclusion: LCBDE is feasible and appears safe as a secondary procedure after failed ERCP. The new technologies and the advancement of surgical techniques will continue to improve success and reduce morbidity.
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Affiliation(s)
- Mahmoud Al-Ardah
- Gwent Center for Digestive Diseases, Royal Gwent Hospital, Newport, Wales, United Kingdom
| | - Rebecca E Barnett
- Gwent Center for Digestive Diseases, Royal Gwent Hospital, Newport, Wales, United Kingdom
| | - Harriet Whewell
- Gwent Center for Digestive Diseases, Royal Gwent Hospital, Newport, Wales, United Kingdom
| | - Tamsin Boyce
- Gwent Center for Digestive Diseases, Royal Gwent Hospital, Newport, Wales, United Kingdom
| | - Ashraf Rasheed
- Gwent Center for Digestive Diseases, Royal Gwent Hospital, Newport, Wales, United Kingdom
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Gnecco J, Brown LK, Boregowda U, Abidali H, Saligram S, Rosenkranz L, Patel S, Haluskza O, Sayana H. Pancreatic Stones and Extracorporeal Shockwave Lithotripsy: A Review of the Literature. Pancreas 2022; 51:916-922. [PMID: 36607935 DOI: 10.1097/mpa.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pancreatic stones are sequelae of chronic pancreatitis, resulting in poor quality of life, frequent hospitalizations, and a significant economic burden. Extracorporeal shock wave lithotripsy (ESWL) can be used to treat pancreatic stones and is less invasive when compared to other modalities. In this review article, we have discussed the role of ESWL in the treatment of pancreatic stones and how it differs from other modalities. Databases were searched electronically for articles discussing the treatment of pancreatic ductal stones by ESWL or other modalities. Articles discussing or comparing treatment success rates were preferentially included. An inductive approach was used to identify articles related to the treatment of pancreatic stones with ESWL throughout the review process. Although laser lithotripsy and electrohydraulic lithotripsy appear to have higher success rates, the potential for ESWL to affect clinical outcomes is substantial, especially in individuals with a higher risk for invasive procedures. The decision to perform ESWL should be considered if the outcome will substantially alter the clinical management when performed by an experienced endoscopist. Further randomized controlled trials are needed to compare ESWL and peroral pancreatic lithotripsy methods.
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Affiliation(s)
| | - Landon K Brown
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
| | - Umesha Boregowda
- Department of Hospital Medicine, Bassett Medical Center, Cooperstown, NY
| | - Hussein Abidali
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
| | - Shreyas Saligram
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
| | - Laura Rosenkranz
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
| | - Sandeep Patel
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
| | - Oleh Haluskza
- Department of Gastroenterology, University of Arizona, Tucson, AZ
| | - Hari Sayana
- Division of Gastroenterology, University of Texas Health Science at San Antonio, San Antonio, TX
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Cianci P, Restini E. Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J Gastroenterol 2021; 27:4536-4554. [PMID: 34366622 PMCID: PMC8326257 DOI: 10.3748/wjg.v27.i28.4536] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/02/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gallstone disease and complications from gallstones are a common clinical problem. The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment. Bile duct stones are a frequent condition associated with cholelithiasis. Amidst the total cholecystectomies performed every year for cholelithiasis, the presence of bile duct stones is 5%-15%; another small percentage of these will develop common bile duct stones after intervention. To avoid serious complications that can occur in choledocholithiasis, these stones should be removed. Unfortunately, there is no consensus on the ideal management strategy to perform such. For a long time, a direct open surgical approach to the bile duct was the only unique approach. With the advent of advanced endoscopic, radiologic, and minimally invasive surgical techniques, however, therapeutic choices have increased in number, and the management of this pathological situation has become multidisciplinary. To date, there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis, but a debate still exists on how to cure the two diseases at the same time. In the era of laparoscopy and mini-invasiveness, we can say that therapeutic approaches can be performed in two sessions or in one session. Comparison of these two approaches showed equivalent success rates, postoperative morbidity, stone clearance, mortality, conversion to other procedures, total surgery time, and failure rate, but the one-session treatment is characterized by a shorter hospital stay, and more cost benefits. The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology, clinical and diagnostic aspects, and possible treatments and their advantages and limitations.
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Affiliation(s)
- Pasquale Cianci
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
| | - Enrico Restini
- Department of Surgery and Traumatology, Hospital Lorenzo Bonomo, Andria 76123, Italy
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Lesmana CRA, Paramitha MS, Lesmana LA. Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery. World J Gastrointest Endosc 2021; 13:198-209. [PMID: 34326941 PMCID: PMC8311469 DOI: 10.4253/wjge.v13.i7.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/18/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
Common bile duct (CBD) stone is a common biliary problem, which often requires endoscopic approach as the initial treatment option. Roughly, 7%-12% of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management. In general, there are three classifications of difficult CBD stone, which are based on the characteristics of the stone (larger than 15 mm, barrel or square-shaped stones, and hard consistency), accessibility to papilla related to anatomical variations, and other clinical conditions or comorbidities of the patients. Currently, endoscopic papillary large balloon dilation (EPLBD) of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts. If failed extraction is still encountered, mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered. Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available. To our knowledge, conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches. The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones.
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Affiliation(s)
- Cosmas Rinaldi Adithya Lesmana
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
- Digestive Disease and GI Oncology Center, Medistra Hospital, Jakarta 12950, DKI, Indonesia
| | - Maria Satya Paramitha
- Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, DKI, Indonesia
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Hwang S, Jung DH, Lee SK, Kim MH. Indication and surgical techniques of bypass choledochojejunostomy for intractable choledocholithiasis. Ann Hepatobiliary Pancreat Surg 2021; 25:259-264. [PMID: 34053929 PMCID: PMC8180391 DOI: 10.14701/ahbps.2021.25.2.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
Despite development in endoscopic treatment and minimally invasive surgery for choledocholithiasis, there remains a small number of patients who require bypass Roux-en-Y choledochojejunostomy (RYCJ) because of the intractable occurrence of common bile duct (CBD) stones. We herein present the detailed procedures of open RYCJ customized for intractable choledocholithiasis. The first method is a side-to-end choledochojejunostomy with intraluminal closure of the distal CBD. This method was applied to a 79-year-old female patient who underwent endoscopic retrograde cholangiopancreatography (ERCP) more than 10 times in the past 14 years (Case No. 1). The distal CBD was explored through choledochotomy and then the distal CBD lumen was occluded with internal running sutures. A large-sized choledochojejunostomy was performed. The patient recovered uneventfully and has been doing well for the past 2 years. The second method is an end-to-end choledochojejunostomy with segmental CBD resection. It was applied to a 75-year-old male patient who underwent ERCP 9 times in the past 10 years (Case No. 2). The CBD was resected segmentally and a large-sized choledochojejunostomy was performed. The patient also recovered uneventfully and has been doing well for the past 2 years. In conclusion, the primary indication of bypass RYCJ is intractable choledocholithiasis which requires numerous sessions of endoscopic stone removal over a long period. Open RYCJ is the preferred procedure to date. If the papilla is patulous, the distal CBD should be occluded or resected to prevent reflux ascending cholangitis. We recommend to resect the intrapancreatic distal CBD if it is markedly dilated like choledochal cyst.
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Affiliation(s)
- Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lamanna A, Maingard J, Tai J, Ranatunga D, Goodwin M. Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis. Diagn Interv Imaging 2019; 100:793-800. [DOI: 10.1016/j.diii.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/18/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023]
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Wang H, Ou Y, Ou J, Jian Z. Complication Analysis with Percutaneous Postoperative Choledochoscopy in 826 Patients: A Single-Center Study. J Laparoendosc Adv Surg Tech A 2019; 29:995-999. [PMID: 30939056 DOI: 10.1089/lap.2019.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Advances in choledochoscopy technology lead to an improvement in the treatment of hepatolithiasis. The aim of this study is to analyze the complications and efficacy of percutaneous postoperative choledochoscopy (PPOC) for residual stones. Materials and Methods: Retrospective analysis of patients who underwent PPOC for residual stones. Main outcome measures included the rate of stone removal and postoperative complications. Results: Eight hundred twenty-six patients received PPOC. The average duration of choledochoscopy was 30 min (range, 14-42 min). Complications included basket incarceration, T-tube dislodgement, bleeding, bile leaks, and infection. Residual stone clearance rate was achieved in 97% of the cases. Conclusions: PPOC is a safe and effective approach for residual stones.
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Affiliation(s)
- Huiling Wang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Yingliang Ou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Jinrui Ou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Zhixiang Jian
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
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Du X, Qian C, Piao S, Pan Z, Jin X. Surgical Treatment of Incarcerated Calculi via Laparoscopic Bile Duct Exploration Using Laparotomy Biliary Lithotomy Forceps under the Guidance of Choledochoscope. Am Surg 2019. [DOI: 10.1177/000313481908500211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Xichen Du
- Department of General Surgery Affiliated Hospital of Jinlin Medical University Jilin, China
| | - Changshi Qian
- Department of Hepatopancreatobiliary Surgery Affiliated Hospital of Yanbian University Yanji, China
| | - Shengjun Piao
- Department of Hepatopancreatobiliary Surgery Affiliated Hospital of Yanbian University Yanji, China
| | - Zhijia Pan
- Department of Hepatopancreatobiliary Surgery Affiliated Hospital of Yanbian University Yanji, China
| | - Xinglin Jin
- Department of Hepatopancreatobiliary Surgery Affiliated Hospital of Yanbian University Yanji, China
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Libânio D, Giestas S, Martinez-Ares D, Canena J, Lopes L. Cholangioscopy-guided holmium laser lithotripsy of a stone trapped in a mechanical lithotripter. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2018; 3:127-128. [PMID: 29916494 PMCID: PMC6004515 DOI: 10.1016/j.vgie.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Diogo Libânio
- Gastroenterology Department, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Sílvia Giestas
- Gastroenterology Department, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - David Martinez-Ares
- Gastroenterology Department, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Jorge Canena
- Centre of Gastroenterology, CUF Infante Santo, Lisboa, Portugal
| | - Luís Lopes
- Gastroenterology Department, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
- School of Medicine, University of Minho, Braga, Portugal
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10
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Mizrahi M, Khoury T, Wang Y, Cohen J, Sheridan J, Chuttani R, Berzin TM, Sawhney MS, Pleskow DK. "Apple Far from the Tree": comparative effectiveness of fiberoptic single-operator cholangiopancreatoscopy (FSOCP) and digital SOCP (DSOCP). HPB (Oxford) 2018; 20:285-288. [PMID: 29107445 DOI: 10.1016/j.hpb.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/10/2017] [Accepted: 09/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND While the fiberoptic single-operator cholangiopancreatoscopy (FSOCP) system has demonstrated efficacy in the diagnosis and management of pancreaticobiliary diseases, the digital SOCP (DSOCP) appears to provide higher resolution digital imaging, however a comparison of these devices has not been established. The aim of this work was to compare the efficacy of FSOCP and DSOCP in biliary stone disease and indeterminate biliary strictures. METHODS A retrospective analysis of a prospective cohort was performed in patients undergoing FSOCP or DSOCP demographics included indication, diagnostic yield, procedure time, radiation dose, and complications. RESULTS 324 patients underwent cholangioscopy. FSOCP and DSOCP were utilized in 198 and 126 patients respectively. Male/female ratio was similar and mean age was 66 ± 13 years. Indications included stone disease, indeterminate stricture evaluation and "other" were 47%, 42% and 11% respectively. Mean procedure time for stone disease and the amount of radiation doses in DSOCP group were lower than the FSOCP group (P = 0.032 and P = 0.02, respectively). Diagnostic yield in indeterminate strictures was higher 78% with DSOCP system compared to 37% with FSOCP system (P = 0.004). Complication were low and similar between the groups. CONCLUSIONS DSOCP system provides enhanced diagnostic yield, shorter procedure times and less radiation exposure compared to FSOCP system.
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Affiliation(s)
| | | | - Yan Wang
- Department of Gastrointestinal Endoscopy, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu, PR China
| | - Jonah Cohen
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer Sheridan
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Ram Chuttani
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Mandeep S Sawhney
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA
| | - Douglas K Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02115, USA.
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Wen XD, Wang T, Huang Z, Zhang HJ, Zhang BY, Tang LJ, Liu WH. Step-by-step strategy in the management of residual hepatolithiasis using post-operative cholangioscopy. Therap Adv Gastroenterol 2017; 10:853-864. [PMID: 29147136 PMCID: PMC5673016 DOI: 10.1177/1756283x17731489] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 02/04/2023] Open
Abstract
Hepatolithiasis is the presence of calculi within the intrahepatic bile duct specifically located proximal to the confluence of the left and right hepatic ducts. The ultimate goal of hepatolithiasis treatment is the complete removal of the stone, the correction of the associated strictures and the prevention of recurrent cholangitis. Although hepatectomy could effectively achieve the above goals, it can be restricted by the risk of insufficient residual liver volume, and has a 15.6% rate of residual hepatolithiasis. With improvements in minimally invasive surgery, post-operative cholangioscopy (POC), provides an additional option for hepatolithiasis treatment with higher clearance rate and fewer severe complications. POC is very safe, and can be performed repeatedly until full patient benefit is achieved. During POC three main steps are accomplished: first, the analysis of the residual hepatolithiasis distribution indirectly by imaging methods or directly endoscopic observation; second, the establishment of the surgical pathway to relieve the strictures; and third, the removal of the stone by a combination of different techniques such as simple basket extraction, mechanical fragmentation, electrohydraulic lithotripsy or laser lithotripsy, among others. In summary, a step-by-step strategy of POC should be put forward to standardize the procedures, especially when dealing with complicated residual hepatolithiasis. This review briefly summarizes the classification, management and complications of hepatolithiasis during the POC process.
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Affiliation(s)
- Xu-dong Wen
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Tao Wang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Zhu Huang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Hong-jian Zhang
- Department of General Surgery, The 515th Hospital of PLA, Wuxi, Jiangsu Province, China
| | - Bing-yin Zhang
- General Surgery Center, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Li-jun Tang
- General Surgery Center of PLA, Chengdu Military General Hospital, 270 Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Wei-hui Liu
- General Surgery Center of PLA, Chengdu Military General Hospital, 270 Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province, 610083, China
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Jiang H, Wang SY, Jin XL, Jin JC, Gu HB, Zhang FM. Surgical treatment of incarcerated calculi via laparoscopic bile duct exploration using laparotomy biliary lithotomy forceps. Exp Ther Med 2016; 12:2314-2316. [PMID: 27698730 DOI: 10.3892/etm.2016.3618] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/14/2016] [Indexed: 01/22/2023] Open
Abstract
The present study aimed to investigate the practicability and clinical value of applying laparotomy biliary lithotomy forceps to laparoscopic bile duct exploration (LCBDE) for the surgical treatment of incarcerated calculi. A total of 63 patients were diagnosed with cholecystolithiasis and choledocholithiasis. The present study performed a retrospective analysis of clinical samples from 16 of these patients who had incarcerated calculi at the terminus of the common bile duct, and who had been treated with laparoscopic cholecystectomy and LCBDE. During the procedure, laparotomy biliary lithotomy forceps were used to gently remove the calculi from the common bile duct. Of the surgical procedures that used laparotomy biliary lithotomy forceps, one case was unsuccessful and 15 cases were successful. The results of the present study suggested that it may be clinically advisable to use laparotomy biliary lithotomy forceps to remove incarcerated calculi from the common bile duct during a laparoscopy, since it is easy, economical and effective.
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Affiliation(s)
- H Jiang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
| | - S Y Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
| | - X L Jin
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
| | - J C Jin
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
| | - H B Gu
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
| | - F M Zhang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P.R. China
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13
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Bhandari S, Bathini R, Sharma A, Maydeo A. Usefulness of single-operator cholangioscopy-guided laser lithotripsy in patients with Mirizzi syndrome and cystic duct stones: experience at a tertiary care center. Gastrointest Endosc 2016; 84:56-61. [PMID: 26764195 DOI: 10.1016/j.gie.2015.12.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/28/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS ERCP is an established technique for the management of bile duct stones. Large bile duct stones (>1.2 cm) require additional techniques such as mechanical lithotripsy and balloon sphincteroplasty for ductal clearance. The literature on endoscopic management of cystic duct stones (CDSs) and Mirizzi syndrome (MS) is limited. We report our experience with cholangioscopy-assisted extraction of CDSs and MS in patients in whom conventional endoscopic and surgical techniques failed. METHODS Between August 2011 and August 2014, 50 patients (15 males) diagnosed with MS (n = 40) and CDSs (n = 10) were recruited for the study. MRCP was the preferred diagnostic modality to outline the biliary anatomy. ERCP was performed by using an Olympus TJF 160/180 duodenoscope (Olympus, Tokyo, Japan). Cholangioscopy was performed by using the Spyglass system (Boston Scientific, Marlborough, Mass). Holmium laser lithotripsy (LL) was performed when conventional stone extraction techniques failed. RESULTS Cholangioscopy-guided LL was required in 34 of 50 patients (68%) with MS and CDSs. Stone extractions using conventional endoscopy techniques were successful in 8 patients and with surgery in another 8 patients, and these patients were excluded from the final statistical analysis. The mean stone size for MS was 21 mm (range 15-41 mm), and the CDS size was 8 mm (range 6-12 mm). Single-session ductal clearance could be achieved in 32 patients (94%). Adverse events were mild and included fever (2 patients), transient abdominal pain (2 patients), and self-limited pancreatitis (2 patients). CONCLUSIONS Cholangioscopy-guided LL is a useful technique for extraction of CDSs and in MS with high single-session success rates. It is also a rescue technique in patients in whom surgical stone extraction failed.
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Affiliation(s)
| | - Rajesh Bathini
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - Atul Sharma
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, India
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Management of impacted common bile duct stones during a laparoscopic procedure: A Retrospective Cohort Study of 377 Consecutive Patients. Int J Surg 2016; 32:1-5. [PMID: 27321383 DOI: 10.1016/j.ijsu.2016.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/12/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION To explore the techniques for managing impacted common bile duct (CBD) stones during laparoscopic common bile duct exploration (LCBDE). METHODS We retrospectively analyzed 377 consecutive patients undergoing LCBDE from January 2008 to June 2015. Group 1 was defined as patients with impacted CBD stones. Group 2 included patients without impacted CBD stones. The outcomes of LCBDE were compared between the two groups. RESULTS There were 65 patients in Group 1 and 312 patients in Group 2. The incidence of jaundice, abnormal liver function tests, cholangitis and pancreatitis was higher in Group 1. Forty-one patients with small impacted CBD stones were managed using the tipless Nitinol basket. Seventeen patients with large impacted CBD stones and 7 patients with small impacted CBD stones underwent laser lithotripsy via choledochoscopy. None of the patients in Group 1 was converted to open procedures for impacted CBD stones. Operation duration was 13.6 min longer in Group 1 (133.2 min). Postoperative hospital stay was significantly longer in Group 1 (9.7 ± 2.5 d) than in Group 2 (6.3 ± 1.8 d). There was no difference in the overall postoperative complication rate, retained stone rate, and recurrence rate between the two groups. CONCLUSION Rational utilization of laser lithotripsy and an appropriate basket in LCBDE may avoid conversion to open procedures in patients with impacted CBD stones.
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15
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Costi R, Gnocchi A, Di Mario F, Sarli L. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol 2014; 20:13382-13401. [PMID: 25309071 PMCID: PMC4188892 DOI: 10.3748/wjg.v20.i37.13382] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/23/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of "risk of carrying CBDS" has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of "under-studying" by poor diagnostic work up or "over-studying" by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. "Low risk" patients do not require further examination before laparoscopic cholecystectomy. Two main "philosophical approaches" face each other for patients with an "intermediate to high risk" of carrying CBDS: on one hand, the "laparoscopy-first" approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the "endoscopy-first" attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of retained stones and need for further procedures. Nevertheless, open surgery is invasive, whereas the laparoscopic common bile duct clearance is time consuming, technically demanding and involves dedicated instruments. Thus, although no consensus has been achieved and CBDS management seems more conditioned by the availability of instrumentation, personnel and skills than cost-effectiveness, endoscopic treatment is largely preferred worldwide.
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Shi D, Yu CG. Comparison of Two Capture Methods for Endoscopic Removal of Large Common Bile Duct Stones. J Laparoendosc Adv Surg Tech A 2014; 24:457-61. [PMID: 24987842 DOI: 10.1089/lap.2013.0509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ding Shi
- Department of Gastroenterology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Cheng-Gong Yu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Oza VM, Kahaleh M. Endoscopic management of chronic pancreatitis. World J Gastrointest Endosc 2013; 5:19-28. [PMID: 23330050 PMCID: PMC3547116 DOI: 10.4253/wjge.v5.i1.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 09/23/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.
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Affiliation(s)
- Veeral M Oza
- Veeral M Oza, Michel Kahaleh, Division of Gastroenterology and Hepatology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY 10021, United States
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Trikudanathan G, Navaneethan U, Parsi MA. Endoscopic management of difficult common bile duct stones. World J Gastroenterol 2013; 19:165-173. [PMID: 23345939 PMCID: PMC3547556 DOI: 10.3748/wjg.v19.i2.165] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/18/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities.
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Stefanidis G, Christodoulou C, Manolakopoulos S, Chuttani R. Endoscopic extraction of large common bile duct stones: A review article. World J Gastrointest Endosc 2012; 4:167-79. [PMID: 22624068 PMCID: PMC3355239 DOI: 10.4253/wjge.v4.i5.167] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/14/2012] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
Since therapeutic endoscopic retrograde cholangiopancreatography replaced surgery as the first approach in cases of choledocolithiasis, a plethora of endoscopic techniques and devices appeared in order to facilitate rapid, safe and effective bile duct stones extraction. Nowadays, endoscopic sphincterotomy combined with balloon catheters and/or baskets is the routine endoscopic technique for stone extraction in the great majority of patients. Large common bile duct stones are treated conventionally with mechanical lithotripsy, while the most serious complication of the procedure is “basket and stone impaction” that is predominately resolved surgically. In cases of difficult, impacted, multiple or intrahepatic stones, more sophisticated procedures have been used. Electrohydraulic lithotripsy and laser lithotripsy are performed using conventional mother-baby scope systems, ultra-thin cholangioscopes, thin endoscopes and ultimately using the novel single use, single operator SpyGlass Direct Visualization System, in order to deliver intracorporeal shock wave energy to fragment the targeted stone, with very good outcomes. Recently, large balloon dilation after endoscopic sphincterotomy confirmed its effectiveness in the extraction of large stones in a plethora of trials. When compared with mechanical lithotripsy or with balloon dilation alone, it proved to be superior. Moreover, dilation is an ideal alternative in cases of altered anatomy where access to the papilla is problematic. Endoscopic sphincterotomy followed by large balloon dilation represents the onset of a new era in large bile duct stone extraction and the management of “impaction” because it seems that is an effective, inexpensive, less traumatic, safe and easy method that does not require sophisticated apparatus and can be performed widely by skillful endoscopists. When complete extraction of large stones is unsuccessful, the drainage of the common bile duct is mandatory either for bridging to the final therapy or as a curative therapy for very elderly patients with short life expectancy. Placing of more than one plastic endoprostheses is better while the administration of Ursodiol is ineffective. The great majority of patients with large stones can be treated endoscopically. In cases of unsuccessful stone extraction using balloons, baskets, mechanical lithotripsy, electrohydraulic or laser lithotripsy and large balloon dilation, the patient should be referred for extracorporeal shock wave lithotripsy or a percutaneous approach and finally surgery.
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Affiliation(s)
- Gerasimos Stefanidis
- Gerasimos Stefanidis, Christos Christodoulou, Department of Gastroenterology, Athens Naval Hospital, 70 Deinokratous St, 115 21 Athens, Greece
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Entrapment of a Dormia Basket in the Cystic Duct: Case Report. Case Rep Surg 2012; 2012:731230. [PMID: 23094183 PMCID: PMC3475299 DOI: 10.1155/2012/731230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/24/2012] [Indexed: 11/17/2022] Open
Abstract
Nowadays endoscopic treatment of common bile duct stones is considered the treatment of choice for all common bile duct stones. Although this procedure is related to a good success rate, in rare cases serious complications can happen, especially if you use a Dormia basket. Here we describe the clinical case of a patient affected by hepatolithiasis, cholelithiasis, and common bile duct lithiasis with entrapment of a Dormia basket in the cystic duct. It was necessary to perform a surgical choledochotomy to deal with this rare complication.
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Maydeo A, Kwek BEA, Bhandari S, Bapat M, Dhir V. Single-operator cholangioscopy-guided laser lithotripsy in patients with difficult biliary and pancreatic ductal stones (with videos). Gastrointest Endosc 2011; 74:1308-1314. [PMID: 22136776 DOI: 10.1016/j.gie.2011.08.047] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scant data exist on the utility of the holmium:yttrium-aluminum-garnet laser for the treatment of biliary or pancreatic duct stones. OBJECTIVE To evaluate the efficacy and safety of fiberoptic probe and catheter system-guided holmium laser lithotripsy of difficult biliary and pancreatic duct stones. DESIGN Prospective study. SETTING Tertiary-care referral center. PATIENTS This study involved 64 patients who underwent holmium laser stone fragmentation. INTERVENTION A total of 64 patients (60 bile duct stones, 4 pancreatic duct stones) underwent endoscopic retrograde stone fragmentation with a holmium laser and a fiberoptic probe and catheter system. The inclusion criterion for bile duct stones was stones not amenable to retrieval by mechanical lithotripsy and/or balloon sphincteroplasty or standard techniques. Pancreatic duct stones included in this study were not amenable to removal by stone retrieval basket or balloon. MAIN OUTCOME MEASUREMENTS Rates of ductal clearance and procedural complications. RESULTS All 64 patients had successful fragmentation of biliary and pancreatic duct stones with the holmium laser. Fifty of 60 patients (83.3%) had complete biliary duct clearance after a single session; 10 patients required an additional session. All pancreatic duct stones were fragmented in a single session. Mean duration of ERCP sessions was 45.9 minutes (range 30-90 minutes). Complications were mild and were encountered in 13.5% of patients; fever (n = 3), transient abdominal pain (n = 4), and biliary stricture (n = 1). LIMITATIONS No comparative treatment group. CONCLUSION The fiberoptic probe and catheter system facilitates transpapillary access for holmium laser fragmentation of difficult biliary and pancreatic duct stones. The technique is safe and highly effective for single-setting duct clearance. Complications are minimal and transient.
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Affiliation(s)
- Amit Maydeo
- Institute of Advanced Endoscopy, Mumbai, India.
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