Laparoscopic transcystic or transcholedochal choledochoscopy during common bile duct exploration for stones? Differences and similarities

Karaliotas, Constantine; Sgourakis, George; Lanitis, Sophocles; Kouloura, Andriana; Karkoulias, Kiriakos; Brontzakis, P.

doi:10.1007/s13126-015-0246-x

Cited by 4 publications

(11 citation statements)

References 39 publications

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“…After LCD, the morbidity rate ranges from 4% to 26.7%, [ 8 , 46 , 62 ] similarly, after ERCP failure, LCD complication rate was 12.5%, 14.3% and 18.8% in Karaliotas et al, 2008 [ 41 ], ours and Karaliotas et al, 2015 [ 28 ] studies respectively, however, after ERCP failure, LCD in non-dilated CBD had 8.7% complication rate in Jinfeng et al, 2016 [ 32 ] study, on the other hand, the morbidity rate post-LCD ranged between 8.3% and 26.6% in Khaled et al, 2013 [ 68 ], Mattila et al, 2017 [ 65 ], Quaresima et al, 2017 [ 4 ], and Deo et al, 2018 [ 70 ] studies. Conversely, there was no major complication after LCD in Zhan et al, 2016 [ 7 ] study.…”

Section: Discussionmentioning

confidence: 87%

“…LCD stone clearance rate ranges from 58.3% to 100%, [ 8 , 46 , 62 ] similarly, it was 80% in our study when including converted cases and 95.2% if excluding them. However, LCD stone clearance rate after ERCP failure was 62.5%, 64.51%, and 100% in Karaliotas et al, 2015 [ 28 ], Karaliotas et al, 2008 [ 41 ], and Karunadasa et al, 2016 [ 63 ] studies respectively, and it was 95.65% when performed after ERCP failure in non-dilated CBD in Jinfeng et al, 2016 [ 32 ] study, while it was 83.3% for impacted stones in Khan et al, 2015 [ 64 ] study. On the other hand, LCD stone clearance rate ranged between 82% and 100% in Mattila et al, 2017 [ 65 ], Quaresima et al, 2017 [ 4 ] Tokumura et al, 2002 [ 66 ], Grubnik et al, 2012 [ 67 ], Jinfeng et al, 2016 [ 1 ], Jinfeng et al, 2016 [ 32 ], Khaled et al, 2013 [ 68 ], Zhou et al, 2017 [ 15 ], Zhan et al, 2016 [ 7 ], and Vindal et al, 2015 [ 69 ] studies.…”

Section: Discussionmentioning

confidence: 99%

“…After ERCP failure, post LCD, missed stone rate was 1.09%, 3.2%, and 4.8% in Karaliotas et al, 2008 [ 41 ], Karaliotas et al, 2015 [ 28 ], and ours studies respectively, however, after ERCP failure, LCD in non-dilated CBD had no retained stone in Jinfeng et al, 2016 [ 32 ] study, while the retained stone rate after LCD for impacted stone reached 6.7% in Khan et al, 2015 [ 64 ] study, on the other hand, the retained stone rate after LCD was in the range of 1.2% and 8% in Jinfeng et al, 2016 [ 32 ], Jinfeng et al, 2016 [ 1 ], Mattila et al, 2017 [ 65 ], Khaled et al, 2013 [ 68 ], Grubnik et al, 2012 [ 67 ], Quaresima et al, 2017 [ 4 ], Tokumura et al, 2002 [ 66 ], and Paganini et al, 2005 [ 61 ] studies, conversely, there was no retained stone rate after LCD in Zhan et al, 2016 [ 7 ], and Vindal et al, 2015 [ 69 ] studies.…”

Section: Discussionmentioning

confidence: 99%

“…The CBD stones were entirely retrieved in all patients using cholecodoscopic extraction techniques (4.5-Fr flexible choledochoscope; Karl Storz, Tuttlingen, Germany) by irrigation, balloon or basket with mechanical lithotripsy when needed. The epigastric port was used to accommodate the operating choledochoscope [ 15 , 18 , [26] , [27] , [28] , [29] ]. After all stones were retrieved and clearance of the bile duct was confirmed with choledochoscopy, the choledochotomy was closed with interrupted 4.0 Vicryl sutures in patients with primary closure of CBD and then IOC was done through the cystic duct to confirm absence of stones and leak ( Fig.…”

Section: Methodsmentioning

confidence: 99%

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Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Gad

Zakaria

Kamel

et al. 2019

Annals of Medicine and Surgery

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Objectives For complicated common bile duct stones (CBDS) that cannot be extracted by endoscopic retrograde cholangiopancreatography (ERCP), management can be safely by open or laparoscopic CBD exploration (CBDE). The study aimed to assess these surgical procedures after endoscopic failure. Methods We analyzed 85 patients underwent surgical management of difficult CBDS after ERCP failure, in the period from 2013 to 2018. Results Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively. An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBDE(LCBDE), open CBDE(OCBDE) and the converted cases were 24.7% (n = 21), 70.6% (n = 60), and 4.7% (n = 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively, Eleven (12.9%) of our patients had postoperative complications without mortality. By comparing LCBDE and OCBDE; there was a significant association between the former and longer operative time. On comparing, T-tube and 1ry CBD closure in both OCBDE and LCBDE, there was significantly longer operative time, and post-operative hospital stays in the former. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay. Conclusion Large difficult CBDS can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Gad

Zakaria

Kamel

et al. 2019

Annals of Medicine and Surgery

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show abstract

“…Frequently, data for both approaches are reported together as combined figures, limiting direct comparison of success rate and safety. Moreover, patients undergoing either of the approaches are treated differently in the postoperative period 11 . The standard surgical approach has been LCD.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of laparoscopic transcysticversustranscholedochal common bile duct exploration for choledocholithiasis

et al. 2019

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Background It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta‐analysis, the success of LTCE versus LCD was evaluated. Methods Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud‐based platform. Random‐effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD −0·86, 95 per cent c.i. −0·97 to −0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD −0·78, −1·14 to −0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.

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Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

Al-Habbal

Reid

Tiang

et al. 2020

Sci Rep

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Debate still exists for the management of choledocholithiasis. The purpose of this study is to quantify the rate of recurrent choledocholithiasis post choledochoscopic bile duct exploration (CBDE) in comparison to ERCP and sphincterotomy, and to demonstrate the feasibility of this approach in a busy metropolitan hospital. Data of patients undergoing CBDE from 2009–2014 at the Northern Hospital, Victoria, Australia, was collected retrospectively. Primary outcomes were bile duct clearance rate and rate of recurrent stones post-clearance. Secondary outcomes measured were post-operative complications, laparoscopic to open conversion rate and operative time. Data of patients undergoing ERCP at the same institution was collected and compared. In total, there were 4,091 cholecystectomy cases performed from 2009–2014, of which 260 (6.3%) of patients had an intraoperative cholangiography (IOC) indicating a common bile duct (CBD) stone. Two hundred and forty-eight patients (95.3%) had a CBDE. The remaining 12 patients (4.6%) had radiological clearance, which were excluded from the study. The overall clearance rate for patients undergoing CBDE was 84% (209/248). The risk of recurrent stones up to 8 years post clearance was 2% (4/209). In the same institution, and between 1998–2012, a total of 1,148 patients underwent ERCP, of which 571 had endoscopic sphincterotomy (ES). Forty-three patients required a repeat ERCP for recurrent CBD stones with a complication rate of 7.5%. Time to recurrence ranged from 6 months to 10 years with a mean of 4.5 years. The rate of recurrence was lower in the CBDE group compared to the patients who had an ERCP (8.9% vs. 2%). CBDE is a feasible and effective method for clearance of CBD stones at the time of laparoscopic cholecystectomy. This approach, although not widely used, reduces the need for ERCP, which has inherent complications. In the longer term, this series showed a significant reduction in the rate of CBD stone recurrence.

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Laparoscopic transcystic or transcholedochal choledochoscopy during common bile duct exploration for stones? Differences and similarities

Cited by 4 publications

References 39 publications

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Meta‐analysis of laparoscopic transcysticversustranscholedochal common bile duct exploration for choledocholithiasis

Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones

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