Laparoscopic Common Bile Duct Exploration in Patients With Gallstones and Choledocholithiasis

Sánchez, Alexis; Rodríguez, Omaira; Sánchez, Rebeca; Benítez, Gustavo

doi:10.4293/108680810x12785289144395

Cited by 19 publications

(20 citation statements)

References 21 publications

(18 reference statements)

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“…There were no retained stones in the two previous reports or the present study, thus supporting entirely opening the cystic duct to avoid retained stones . Previous studies have considered patients with unsuccessful preoperative EST for BDS to be complex cases , and these assessments are consistent with this study. In the present study, 13% of patients with unsuccessful preoperative EST had complications, whereas 12% without preoperative EST had complications.…”

Section: Discussionsupporting

confidence: 90%

“…Complication rates for laparoscopic choledochotomy have been reported to be between 1.2% and 18% for the transcystic approach and between 7% and 18.74% for the direct choledochotomy approach . The incidence of complications among those with unsuccessful preoperative EST in our study was similar to the incidence in these reports . This study demonstrated that the incidence of complications among those with unsuccessful preoperative EST was not significantly higher than among those without the unsuccessful EST.…”

Section: Discussionsupporting

confidence: 84%

See 1 more Smart Citation

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

Otani

Yokoyama

Sato

et al. 2017

Asian J Endoscop Surgery

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 84%

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

Otani

Yokoyama

Sato

et al. 2017

Asian J Endoscop Surgery

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“…In these cases the use of methods to achieve stone fragmentation increases the effectiveness of LCBDE. 1,2 The first experience using laser lithotripsy for the treatment of bile duct stones is attributed to Orii et al 12 in 1983, who reported 8 patients with intrahepatic stones and 3 patients with choledocholithiasis treated with an yttriumaluminum-garnet laser. The procedure was performed shortly after the ineffectiveness of the endoscopic treatment was shown.…”

Section: Discussionmentioning

confidence: 99%

“…In patients in whom ERCP is ineffective, the laparoscopic conversion rate increases mainly because of impacted stones that require complex management. 2 The incorporation of new technologies such as robotic surgery and a holmium laser in the management of choledocholithiasis increases the success rate, allowing proper handling of complex cases. 3,4 Robot-assisted surgery helps to overcome difficulties of other minimally invasive approaches, providing a 3-dimensional view and high maneuverability of the instruments.…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Surgery and Holmium Laser in Complex Choledocholithiasis

Sánchez

Rodríguez

Sánchez

et al. 2015

CRSLS

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Introduction: Unsolved choledocholithiasis by endoscopic retrograde cholangiopancreatography is a complicated condition to manage. The incorporation of robotic surgery, a choledochoscope, and a holmium laser as therapeutic tools is likely to increase surgery effectiveness. Our purpose is to present the first Latin American case report of the combined use of these tools to extract a large impacted bile duct stone.

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“…Furthermore the treatment can be challenging because of the anatomical changes due to the bariatric procedure. 1,2 Diverse kinds of protocols exist: prophylactic surgery (simultaneous cholecystectomy and gastric bypass in every patients, whether they have or not cholelithiasis), 3,4 elective (simultaneous cholecystectomy with conventional gastric bypass in the patients with asymptomatic cholelithiasis), [5][6][7] and conventional cholecystectomy only in the presence of cholelithiasis with symptoms. [8][9][10][11] The incidence of cholelithiasis post gastric bypass is estimated around 37%.…”

mentioning

confidence: 99%

Gallbladder stones in bariatrics and management of choledocholithiasis after gastric bypass

Palermo

Neto²

2019

Gastrointestinal Intervention

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It is known that the rapid weight loss is a predisposing factor to develop biliary lithiasis. The physiopathology is related with an oversaturation of bile with cholesterol, bile stasis, and increase in mucin concentration in bile. The incidence of cholelithiasis post gastric bypass is estimated around 37%. Almost 50% developed disease in the first year of monitoring, and 60% in the first 6 months. Meanwhile the patients undergoing sleeve gastrectomy have an incidence of cholelithiasis of 27%. Diverse kinds of protocols exist: prophylactic surgery (simultaneous cholecystectomy and gastric bypass in every patients, whether they have or not cholelithiasis), elective (simultaneous cholecystectomy with conventional gastric bypass in the patients with asymptomatic cholelithiasis), and conventional cholecystectomy only in the presence of cholelithiasis with symptoms. Which way to go is still a topic of discussion among surgeons but the majority agree that prophylactic surgery shouldn't be an option because the number of patients that will develop symptomatic cholelithiasis is low (around 6% to 8% of them) and this leads to an elevated number of patients exposed to an unnecessary procedure with potential complications. The presence of gallstones in the common bile duct (CBD) although is a rare complication after Roux-en-Y gastric bypass (around 0.2% of the bariatric patients) represents an important challenge due to the anatomical modifications of the gastrointestinal tract. This leads to having to pursue other methods to reach the papillae for the resolution of choledocholithiasis: laparoscopyassisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), balloon enteroscopy assisted ERCP, percutaneous biliary drainage with subsequent trans fistula treatment and laparoscopic exploration of CBD. Which of these methods should we choose must be based on the surgeon experience, the equipment available and the location of the stone. But whatever the method, a special training is needed on endoscopy, percutaneous surgery and laparoscopy.

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Laparoscopic Common Bile Duct Exploration in Patients With Gallstones and Choledocholithiasis

Abstract: Failed ERCP appears to decrease the success rate of a laparoscopic approach for common bile duct exploration.

Cited by 19 publications

References 21 publications

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

Robot-Assisted Surgery and Holmium Laser in Complex Choledocholithiasis

Gallbladder stones in bariatrics and management of choledocholithiasis after gastric bypass

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