Technique and Results of Laparoscopic Choledochotomy for the Management of Bile Duct Calculi

Robinson, Gregory; Hollinshead, John; Falk, Gregory L.; Moulton, John

doi:10.1111/j.1445-2197.1995.tb00653.x

Cited by 27 publications

(16 citation statements)

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“…The average postoperative hospital stay in our study was 4.73 days (2-14 days) for Group A and 5.91 days (2-22 days) for Group B. (Table 3) This is comparable with many studies reported in the literature [31,33,54,55] and is better compared to several others [29,56]. The patients were allowed orally upon return of bowel activity at an average of 27.82 h for Group A and 28.17 h for Group B.…”

Section: Discussionsupporting

confidence: 92%

Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study

et al. 2014

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Section: Discussionsupporting

confidence: 92%

Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study

et al. 2014

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“…It seems logical to take the next step to complete the transition from a one-stage procedure and perform a choledochotomy. [20][21][22][23][24] It certainly requires more laparoscopic skills, especially suturing, and usually placement of another port; but surgeons who cannot suture laparoscopically should not be doing laparoscopic surgery.…”

Section: Choledochotomymentioning

confidence: 99%

“…13,15,17,24,25 A 30°t elescope is used. The CBD is best exposed by lateral traction on the cystic duct, upward traction on the fundus of the gallbladder, and downward traction on the duodenum with an extra grasper.…”

Section: Choledochotomymentioning

confidence: 99%

The case for laparoscopic common bile duct exploration

Fielding

2002

Journal of Hepato-Biliary-Pancreatic Surgery

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The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.

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“…Nonetheless, it provides unique access to both proximal and distal portions of the bile duct and is particularly useful for management of large or multiple calculi [84,85]. Adjunctive mechanical or electrohydraulic lithotripsy or Candela laser photoablation can facilitate choledochoscopic fragmentation and removal of impacted stones [86,87].…”

Section: Laparoscopic Therapymentioning

confidence: 99%

Laparoscopic Cholecystectomy for Biliary Tract Emergencies: State of the Art

1999

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Although laparoscopic cholecystectomy is unusually safe and well tolerated in patients with routine symptomatic cholelithiasis, it can become a formidable procedure when used to manage biliary tract emergencies. Optimally, a reasoned and cautious approach and a low threshold for conversion can avoid major complications. One such emergency, acute cholecystitis, may be particularly hazardous because of the relatively common finding of severe inflammation with dense adhesions to adjacent viscera and gallbladder necrosis. Special modifications of technique may be required. Overall, urgent operation (within 72 hours) results in an acceptably low mortality (0.3%) but a somewhat higher conversion rate (16%) and longer hospital stay (3 days). Unnecessary delays may result in more adhesions and an increased level of operative difficulty. In patients who are at an especially high risk because of co-morbid disease, percutaneous cholecystostomy is an appropriate alternative strategy. Biliary pancreatitis may be associated with high mortality (9%) and has an unpredictable course. Accordingly, a multidisciplinary approach that may include both gastroenterologists and radiologists is generally advisable. Because common bile duct (CBD) stones are present in more than 20% of patients who present with biliary pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) can be used effectively on a selective basis during the preoperative or postoperative period; the preferred timing continues to be somewhat controversial. As an alternative approach, laparoscopic CBD exploration is gradually gaining wider acceptance. In eight reported series using a variety of techniques for stone extraction, major complications were infrequent (10%), and the conversion rate was low (5%). Acute suppurative cholangitis is a more fulminant problem that is best managed by expeditious ERCP with removal of all intraductal stones. Resuscitation should be continued until complete; laparoscopic cholecystectomy can follow at an appropriate interval.

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Technique and Results of Laparoscopic Choledochotomy for the Management of Bile Duct Calculi

Cited by 27 publications

References 0 publications

Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study

Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study

The case for laparoscopic common bile duct exploration

Laparoscopic Cholecystectomy for Biliary Tract Emergencies: State of the Art

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