Comment on “Conventional Surgical Management of Bile Duct Stones

Navaratne, Lalin; Al-Musawi, Jasim; Isla, Alberto

doi:10.1097/sla.0000000000004951

Cited by 11 publications

(3 citation statements)

References 9 publications

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“…One of the main complications is biliary leakage, but this is mainly associated with the transductal approach, and it can be minimized by increasing the use of the transcystic route (32,33). This has been reported to be facilitated using the leveraging access to technology and enhanced surgical technique (LATEST) approach (34). In the present series, the only two complications were related to self-limiting bile leakage related to the transductal approach.…”

Section: Discussionmentioning

confidence: 61%

Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

López-López

Navaratne

Ferreras

et al. 2023

Langenbecks Arch Surg

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BackgroundThe physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. MethodsA retrospective multicenter study of all patients who underwent LBDE during pregnancy from ve centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. ResultsFive from 17 centers, with a total of 3950 LBDEs reported performing LBDE during pregnancy with a cumulative experience of eight patients (0.2%). Median surgical time was 75 minutes (range: 60-140 minutes). The bile duct was cleared successfully in all patients and the median hospital stay was 2 days (range:1-3 days). The literature review identi ed a total of seven patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal or pregnancy-related complications in any of the total 15 patients included. ConclusionThe limited available data suggests that LBDE during pregnancy is a safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.

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Section: Discussionmentioning

confidence: 61%

Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

López-López

Navaratne

Ferreras

et al. 2023

Langenbecks Arch Surg

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“…Its focus is on technical or technological aspects necessary to achieve high rates of transcystic exploration 31–33 . In turn, this leads to minimizing the complications associated with the transductal approach and shorter hospital stays 34 . Also, it requires the availability of a theater that effectively runs like an emergency theater, equipment, and staff to perform lithotripsy.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33] In turn, this leads to minimizing the complications associated with the transductal approach and shorter hospital stays. 34 Also, it requires the availability of a theater that effectively runs like an emergency theater, equipment, and staff to perform lithotripsy. Furthermore, teaching and mentoring are extremely important elements of Biliary Surgery 2.0.…”

Section: F I G U R Ementioning

confidence: 99%

Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era

Durán

Silvestre

Hernández

et al. 2022

J Hepato Biliary Pancreat

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Background Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto‐choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. Methods We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre‐, intra‐, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. Results A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1‐14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1–38), (2) Competence (39–61) and (3) Proficiency (62–110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P < .001). A significant decrease in the operative time (150.9 vs 117.6 vs 99.9 min; P < .001) and complication rate (21.1% vs 21.7% vs 2%; P = .01) were observed across the three phases. Conclusion Our data suggest that the learning curve for complete competence in LC + LCBDE is approximately 60 cases, provided that proper training is available. The initial learning phase can be carried out safely and efficiently with acceptable results.

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Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

López-López

Gil-Vazquez

Ferreras

et al. 2022

J Hepato Biliary Pancreat

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Comment on “Conventional Surgical Management of Bile Duct Stones

Cited by 11 publications

References 9 publications

Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review

Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era

Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

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