Fortuitous discovery of common bile duct stones: Results of a conservative strategy

Balandraud, Paul; Biance, N.; Peycru, T.; Tardat, E.; Bonnet, P; Cazeres, Christophe; Hardwigsen, Jean

doi:10.1016/j.gcb.2008.02.023

Cited by 12 publications

(14 citation statements)

References 19 publications

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“…Such problems can occur without warning,23 but not all patients will experience difficulties secondary to CBDS. Studies confirm that a number of patients will spontaneously pass ductal stones into their duodenum before or after laparoscopic cholecystectomy 14 24 25. That small unsuspected stones can have a benign natural history is also supported by trials of selective IOC, where the incidence of CBDS-related complications in patients who do not undergo cholangiography is reported to be low 17–20 26.…”

Section: General Principles In the Management Of Cbdsmentioning

confidence: 89%

Updated guideline on the management of common bile duct stones (CBDS)

Williams

Beckingham

Sayed

et al. 2017

Gut

367

293

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Section: General Principles In the Management Of Cbdsmentioning

confidence: 89%

Updated guideline on the management of common bile duct stones (CBDS)

Williams

Beckingham

Sayed

et al. 2017

Gut

367

293

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“…IOC could help to avoid the morbidity and mortality of ERCP [35]. On the other hand, surgeons who adopt the selective implementation of IOC state that only one third of asymptomatic CBD stones need intervention [36]. In the scientific literature there are several articles that have reported a similar series without IOC [37][38][39][40][41].…”

Section: Discussionmentioning

confidence: 99%

Bile Duct Injury during Laparoscopic Cholecystectomy without Intraoperative Cholangiography: A Retrospective Study on 1,100 Selected Patients

Pesce

Portale²,

Minutolo³

et al. 2012

Dig Surg

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Background: Whether to routinely or selectively use intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) has been a controversial issue for many years. Many authors maintain that IOC decreases the rate of biliary complications such as bile duct injuries, biliary leak, and missed common bile duct (CBD) stones. However, in contrast to these claims, many centers have opted to perform LC without IOC. In this retrospective study, the results of a series of 1,100 LCs, all of which involved major biliary complications and which were performed without the use of IOC, were reviewed. Methods: Data from 1,100 selected patients (728 females and 372 males) undergoing LC without the use of IOC from January 2003 to November 2011 were analyzed. One hundred and seventy LCs were performed by young surgeons during the learning curve, and 930 by surgeons with over 10 years of experience. Two techniques were used to create pneumoperitoneum: the Veress technique in 319 cases (29%) and the Hasson technique in the remaining 781 cases (71%). Patients with a suspicion of CBD stones were excluded from the study. Results: Two CBD injuries (0.18%) and three biliary leaks (0.27%) were detected among this group. Thirty-three patients (3%) needed conversion to open cholecystectomy. Missed CBD stones were reported in 4 cases (0.36%). There was no postoperative mortality. Conclusion: LC can be performed safely without the use of IOC and with acceptable low rates of biliary complications. An accurate preoperative evaluation of clinical risk factors, precise operative procedures, and conversion to an open approach in doubtful cases are important measures which must be taken to prevent CBD injury.

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“…Nevertheless, some authors found that after ERCP clearance, 13% of patients appeared to still have CBD stones at the time of exploration [9]. On the other hand, authors who adopt the selective IOC policy state that only one third of asymptomatic CBD stones need intervention [33,34]. Furthermore, of the so-called ''positive'' IOC for stones, only 50-65% of cases are proved to truly have stones [35,36].…”

Section: Discussionmentioning

confidence: 99%

“…As regards missed CBD stones, the three policies were found to have comparable ranges, namely, from 0.0 to 1.55% for series without IOC [15][16][17][38][39][40][41][42][43][44][45], from 0.0 to 0.10% for series with a selective IOC policy [33,34,37], and from 0.0 to 0.67% for a routine IOC policy [29][30][31].…”

Section: Discussionmentioning

confidence: 99%