Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones

Abstract

Cholelithiasis is a kind of common and multiple diseases. In recent years, traditional laparotomy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. (1) For intrahepatic bile duct stones, the operation may be selected by laparoscopic liver resection, laparoscopic common bile duct exploration (LCBDE), or percutaneous transhepatic cholangioscopy. (2) For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows: laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. (3) For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Percutaneous Transhepatic Cholangioscopy and Lithotripsy for Intrahepatic Biliary Stones and Sclerosing Cholangitis Secondary to Kasai Procedure for Biliary Atresia: A Case Report

“…Both the use of antibiotics for intestinal decontamination and that of PTC or surgical revision for mechanical relief of biliary obstruction have been previously reported for this condition [6]. Additionally, cases of endoscopic treatment with the use of balloon-assisted ERCP have also been reported [5,6]. However, in those cases in which patients are unsuitable for surgery, or those in which balloon-assisted ERCP fails to establish bile cannulation, PTCS may be the optimal alternative both as diagnostic tool and as therapeutic solution, as described in a few rare cases of PTCS-assisted lithotripsy [9].…”

“…The treatment previously used for recurrent cholangitis caused by biliary obstruction has included surgical revision, percutaneous biliary drainage and, in some rare cases, even endoscopic retrograde cholangiopancreatography (ERCP). Recently, however, the introduction of percutaneous transhepatic cholangiopscopy (PTCS) has improved access to the biliary system in those cases in which a peroral endoscopic approach to the biliary system is difficult or impossible [4,5]. Multiple series using these procedures have demonstrated substantial improvements in mortality, but long-term complications remain a significant problem, with most patients developing cholangitis and liver failure requiring liver transplantation [6].…”

T‐tube‐free single‐incision laparoscopic common bile duct exploration plus cholecystectomy: a single centre experience

“…If the CBD is not dilated, some T‐tube‐related complications may occur, such as electrolyte disturbances, infection, bleeding and bile leakage. Due to the slight interference of laparoscopic surgery in the abdomen cavity, the formation of T‐tube‐related sinus‐tract delays, and the detention time for T‐tubes is prolonged to about 6 weeks …”

“…Due to the slight interference of laparoscopic surgery in the abdomen cavity, the formation of T-tube-related sinus-tract delays, and the detention time for T-tubes is prolonged to about 6 weeks. 10 LC combined with laparoscopic transcystic common bile duct exploration is a one-stage treatment for CBDS without the need for incision on the CBD. Since it does not have to incise and suture the CBD, the risks of bile leakage, bile duct stenosis are avoided.…”

“…The patients selected to undergo this procedure should meet certain criteria: the diameter of CBD is greater than 1 cm; no intrahepatic bile duct stones need to be treated; choledochoscopy confirmed no residual stones in biliary tract; the number of extrahepatic bile duct stones ≤4; CBD inflammation is mild, SO function is normal and without stenosis. 10 Because of the primary closure of the CBD, there is a risk of postoperative bile leakage, abdominal infection, which may lead to a secondary surgery, or even be life-threatening. We performed preoperative ERBD/preoperative ENBD/intraoperative placement of J-tubes in the CBD, which acted similarly to the T-tube in decompression and drainage.…”