Treatment of choledocolithiasis by laparoscopic exploration of the bile tract after failed endoscopic retrograde cholangiopancreatography

Abstract

Introduction: There are three treatment options for choledocholithiasis: endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy; laparoscopic exploration of the main bile duct with concomitant cholecystectomy; and open cholecystectomy with exploration of the main bile duct. Material and methods: A retrospective, descriptive, observational study was taken of patients with a diagnosis of cholecysto-choledocholithiasis that failed ERCP and who underwent laparoscopic cholecystectomy with exploration of the bile duct. Results: From January 2009 to December 2018, 2322 ERCP procedures were performed at Hospital Regional Ignacio Zaragoza, with a failed procedure rate of 3.2% which is equivalent to 75 patients; endoscopic sphincterotomy was performed on all 75 patients and 60 (80%) of these patients had cholelithiasis with choledocholithiasis. Access to the bile duct through choledochotomy was required in all 75 patients, achieving successful stone extraction and bile duct clearance in 95%. Fifteen (20%) of these patients that had had laparoscopic cholecystectomy presented choledocholithiasis de novo more than two years after cholecystectomy. Nine patients underwent laparoscopic cholecystectomy and 6 patients underwent open cholecystectomy. Patients averaged 6 hospital days post-procedure. Surgical times ranged from 150 min to 210 min. Conclusion: Laparoscopic reoperation of the biliary tract is a reasonable alternative for patients with a history of previous biliary surgery who have failed the ERCP approach. Highlights

Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP

“…In our study, once CBDS recurred, the rate of next recurrence increased in proportion to the number of recurrence cases, as previously reported [9] . Varying risk factors have been reported in studies [1–8] . In our study, age (>65 years), presence of concomitant cardiovascular and respiratory diseases, stent or T-tube placement in the common bile duct, a previously known wide common bile duct (diameter ≥ 10 mm), and gallbladder stones were independent risk factors.…”

“…[9] Varying risk factors have been reported in studies. [1][2][3][4][5][6][7][8] In our study, age (>65 years), presence of concomitant cardiovascular and respiratory diseases, stent or T-tube placement in the common bile duct, a previously known wide common bile duct (diameter ≥ 10 mm), and gallbladder stones were independent risk factors.…”

“…[5] A gallbladder with stones (GBS) that is left in place and a large common bile duct are risk factors for recurrent CBDS. [6] A recent study found that the incidence of multiple recurrences was high after the first CBDS recurrence; the second and third recurrence rates were 23.4% and 33.4%, respectively. [7] This study aimed to identify risk factors for multiple recurrences after endoscopic removal of CBDS with EST and needle-knife precut sphincterotomy methods and to elucidate effective interventions to prevent further recurrences.…”

“…Even after complete clearance of the common bile duct, recurrent CBDS is not rare; recurrence rates of 17% have been reported after EST [5] . A gallbladder with stones (GBS) that is left in place and a large common bile duct are risk factors for recurrent CBDS [6] . A recent study found that the incidence of multiple recurrences was high after the first CBDS recurrence; the second and third recurrence rates were 23.4% and 33.4%, respectively [7] .…”

Transcystic versus transcholedochal laparoscopic common bile duct exploration: Choosing the right approach – A Case Series

“…Applying intraoperative cholangiography and intraoperative choledochoscopy to explore choledocholithiasis is safe and effective. 10,11 Dormia basket is used to remove stones with the help of intraoperative cholangiography or intraoperative choledochoscopy. 2 In this series of case reports, two patients with cholecysto-choledocholithiasis underwent laparoscopic cholecystectomy and exploratory choledocholithiasis with intraoperative choledochoscopy.…”