Comparative Evaluation of Two Laparoscopic Procedures for Treating Common Bile Duct Stones

Ai-dong, GU; Li, Xiang-nong; Guo, Ke-xun; Ma, Zu-tai

doi:10.1007/s12013-010-9127-7

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…With advances in laparoscopic techniques and instruments, laparoscopic CBD exploration (LCBDE) has been performed more frequently, and there have been many reports that laparoscopic choledocholithotomy is less invasive than open surgery [ 5 , 6 ]. However, in some patients with a narrow CBD, LCBDE is associated with a high risk of postoperative CBD stricture and bile leakage due to technical difficulty.…”

Section: Introductionmentioning

confidence: 99%

“…To prevent these complications, surgeons have inserted T-tubes during LCBDE; however, T-tube insertion is nevertheless associated with complications, including infections that ascend through the drain, dislocation of the T-tube (which results in bile leakage), and most importantly, patient inconvenience due to prolonged T-tube placement [ 7 ]. Surgeons have proposed a variety of techniques for laparoscopic choledocholithotomy [ 1 , 6 , 8 – 10 ], although there remains no consensus as to the best surgical treatment method.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic CBD exploration using a V-shaped choledochotomy

Kim

Lee

et al. 2015

BMC Surg

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BackgroundLaparoscopic common bile duct exploration (LCBDE) is a treatment modality for choledocholithiasis. The advantages of this technique are that it is less invasive than conventional open surgery and it permits single-stage management; however, other technical difficulties limit its use. The aim of this article is to introduce our novel technique for LCBDE, which may overcome some of the limitations of conventional LCBDE.Since December 2013, ten patients have undergone LCBDE using a V-shaped choledochotomy (V-CBD). After the confluence of the cystic duct and the CBD were exposed, a V-shaped incision was made along the medial wall of the cystic duct and the lateral wall of the common hepatic duct, which comprise two sides of Calot’s triangle. The choledochoscope was inserted into the lumen of the CBD through a V-shaped incision, and all CBD stones were retrieved using a basket or a Fogarty balloon catheter or were irrigated with saline. After CBD clearance was confirmed using the choledochoscope, the choledochotomy was closed with the bard absorbable suture material known as V-loc.ResultsThe diameter of the CBD ranged from 8 to 30 mm, and the mean size of the stones was 11.6 ± 8.4 mm. The mean operative time was 97.8 ± 30.3 min, and the mean length of the postoperative hospital stay was 6.0 ± 4.6 days. All patients recovered without any postoperative complications, except for one patient who developed postoperative pancreatitis. No conversions to laparotomy were observed, and there were no recurrent stones and no need of T-tube insertion.ConclusionsThis report suggests that our novel technique, known as V-CBD, may represent a feasible and straightforward procedure for treating choledocholithiasis, especially when the CBD is not dilated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic CBD exploration using a V-shaped choledochotomy

Kim

Lee

et al. 2015

BMC Surg

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“…There have been varied suggestions on what constitutes the normal range of CBD diameter (in mm) and that of a CBD stricture. It has been estimated that the size of the bile duct increases by one mm per each decade of life after 60 years [ 12 ]. In two separate studies, the maximum CBD diameter was found to be 9 mm after long-term follow-up, following T-tube placement [ 14 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Routine use of T-tube placement and bile drainage still remains controversial. Physical discomfort, cholangitis, tube displacement, bile leakage after tube removal, which could lead to increased mortality and morbidity are some of the reasons cited by proponents against the use of T-tube placement [ 2 , 11 , 12 ]. However, contrary to these arguments, T-tube placement is reported to reduce intrabiliary pressure and edema and may facilitate healing [ 2 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Clinical Study of the Effects of T-Tube Placement for Bile Duct Stricture

Şahiner

Kendirci

2017

Med Sci Monit

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BackgroundT-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement.Material/MethodsRetrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis.ResultsOf the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4–21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found.ConclusionsA retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications.

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“…performed more frequently nowadays as it is less invasive than open surgery although it is associated with risk of postoperative CBD stricture and bile leakage due to technical difficulty. 7,8 The overall success rate of LCBDE was reported to be 94.6%. 9 Surgeons have proposed various laparoscopic techniques for stone extraction during LCBDE, either through the scope method using basket and balloon with choledochoscopic control, direct access extraction of stones using basket, balloon or reticulated graspers with CBD milking, or irrigation/ suction techniques.…”

mentioning

confidence: 99%

Alternative laparoscopic techniques for stone extraction during laparoscopic CBD exploration: pros and cons

Abdelhameed¹,

Abdelmageed²,

Radwan³

2019

Int Surg J

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Background: A prospective work to study various laparoscopic techniques used for stone extraction during laparoscopic common bile duct exploration (LCBDE) with assessment of CBD clearance by each technique with discussion of its feasibility and difficulties.Methods: Patients with chronic calcular cholecystitis with CBD stone(s) were treated randomly by laparoscopic cholecystectomy plus choledocholithotomy. Various methods were used for stone extraction either through the scope technique, direct access technique, or irrigation/suction technique. Assurance of CBD clearance of stones was done later using intra-operative choledochoscopy, cholangiogram, or post operatively using sonography or MRCP.Results: Out of sixty seven patients, laparoscopic CBD stone extraction was done through scope control in 25 patients, direct access technique in 22 patients, while irrigation/suction technique was done in 20 cases. Choledochoscope method was the most effective method for CBD clearance with success rate (96%), it was effective in distal CBD stones of average size (0.5-1.0 cm), and number (1-5), but unfortunately missed stone is a relative risk (4%). Direct access technique is as effective blindly especially if associated with irrigation/suction with success rate (81.8%) specially in non-impacted single distal stone of average size (0.5-1.0 cm) well recognized by MRCP a night before operation. Irrigation / suction technique was the least effective with success rate (50%) only with the need to convert to other technique in 50% of cases.Conclusions: Choledocoscope guided stone extraction technique was the technique of choice for CBD clearance during LCBDE.

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Comparative Evaluation of Two Laparoscopic Procedures for Treating Common Bile Duct Stones

Cited by 9 publications

References 16 publications

Laparoscopic CBD exploration using a V-shaped choledochotomy

Laparoscopic CBD exploration using a V-shaped choledochotomy

Retrospective Clinical Study of the Effects of T-Tube Placement for Bile Duct Stricture

Alternative laparoscopic techniques for stone extraction during laparoscopic CBD exploration: pros and cons

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