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Li H, Zhong QF, Liu QR, Wu Q, Zhang W, Luo GP. Analysis of Efficacy and Safety of Laparoscopy Plus Choledochoscopy Combined With Holmium Laser Lithotripsy for Choledocholithiasis and Hepatolithiasis. Gastroenterology Res 2024; 17:126-132. [PMID: 38993550 PMCID: PMC11236342 DOI: 10.14740/gr1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/29/2024] [Indexed: 07/13/2024] Open
Abstract
Background With the advancement of laparoscopic technology, the combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy has emerged as an effective treatment modality for both choledocholithiasis and hepatolithiasis. This study aimed to assess the efficacy and safety of this approach. Methods Retrospective analysis was conducted on the medical records of 76 patients diagnosed with choledocholithiasis and hepatolithiasis between April 2021 and March 2023. Patients were divided into two groups based on the treatment plan: the control group, which underwent traditional laparotomy and choledochoscopy lithotripsy (n = 38), and the experimental group, which underwent laparoscopy combined with choledochoscopy and holmium laser lithotripsy (n = 38). Comparative analysis was performed on various operation-related parameters, stone-free rate, complication rates, and changes in biochemical, liver function, inflammatory, stress response indicators, and pain scores between the two groups. Results The experimental group demonstrated significantly shorter stone removal time, reduced intraoperative bleeding, and shorter hospital stay compared to the control group (P < 0.05). Moreover, the experimental group exhibited lower incidence of postoperative complications and lower pain scores at 2 weeks to 3 months post-operation (P < 0.05). Biochemical indicators including total bile acid (TBA), total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and glutamyl transpeptidase (GGT) were significantly lower in the observation group compared to the control group (P < 0.05). Additionally, stress and inflammation indicators were also lower in the experimental group (P < 0.05). Conclusions The combination of laparoscopy, choledochoscopy, and holmium laser lithotripsy presents favorable therapeutic outcomes in the management of choledocholithiasis and hepatolithiasis, indicating its potential for widespread clinical application.
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Affiliation(s)
- Hui Li
- Department of General Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Jiangxi 342400, China
| | - Qun Feng Zhong
- Department of Ultrasound Medicine, Xingguo Hospital Affiliated to Gannan Medical College, Jiangxi 342400, China
| | - Qiong Rong Liu
- Department of General Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Jiangxi 342400, China
| | - Qiang Wu
- Department of General Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Jiangxi 342400, China
| | - Wen Zhang
- Department of General Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Jiangxi 342400, China
| | - Guo Pei Luo
- Department of Pancreatic Surgery, Affiliated Cancer Hospital of Fudan University, Shanghai 200000, China
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Pouplin J, Maulat C, Yubero G, Shourick J, Cuellar E, Culetto A, Barange K, Buscail L, Carrere N, Peron JM, Suc B, Bournet B, Boulard P, Muscari F. Curative surgical treatment of common bile duct stones: Retrospective cohort study. World J Surg 2024; 48:692-700. [PMID: 38348553 DOI: 10.1002/wjs.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND In the event of symptomatic common bile duct (CBD) stones with dilated CBD, one possible curative treatment option is stone extraction through choledocotomy associated with cholecystectomy. Endoscopic treatment is only reserved for residual stones at 6 weeks. The aim of this study was to evaluate the results from laparoscopic curative surgical treatment of CBD stones with dilated CBD. METHODS This is a retrospective single-centered cohort study. All consecutive patients admitted for laparoscopic cholecystectomy with evidence of CBD stones with dilated CBD from January 2010 to December 2020 at our center were included. Success was defined by CBD clearance at 6 weeks. Need for additional procedures, such as endoscopic sphincterotomy, immediate, and end-of-procedure morbi-mortality as well as factors associated with procedure failure, were also studied. RESULTS A total of 246 patients who received curative treatment were included in the study. The success rate for the curative treatment was 93.1% (229 patients). Immediate postoperative morbidity was 24.4% with a 5.3% reintervention rate. Immediate and 6-week postoperative mortality rates were zero and 0.4%, respectively. The mean length of stay was 11.3 days. Factors associated with procedure failure appeared to be the occurrence of an early postoperative complication and the need for readmission during the period between surgery and drain removal. CONCLUSION This study indicates that laparoscopic curative surgical treatment for symptomatic CBD stones may be performed with acceptable results without routine need for additional procedures.
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Affiliation(s)
- Julien Pouplin
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Charlotte Maulat
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Gabriel Yubero
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Jason Shourick
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Emmanuel Cuellar
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Adrian Culetto
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Karl Barange
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Louis Buscail
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Nicolas Carrere
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Peron
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Bertrand Suc
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Barbara Bournet
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Paul Boulard
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Fabrice Muscari
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
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Genet D, Souche R, Roucaute S, Borie F, Millat B, Valats JC, Fabre JM, Herrero A. Upfront Laparoscopic Management of Common Bile Duct Stones: What Are the Risk Factors of Failure? J Gastrointest Surg 2023; 27:1846-1854. [PMID: 37106206 DOI: 10.1007/s11605-023-05687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Treatment of common bile duct stones (CBDS) includes laparoscopic cholecystectomy (LC) with either laparoscopic common bile duct exploration (LCBDE) or perioperative endoscopic retrograde cholangiopancreatography (ERCP). The main objective of this study was to identify predictive factors for the failure of upfront and exclusive surgical treatment by LCBDE. METHODS This is a single-center, retrospective study on patients with CBDS and operated for LC between 2007 and 2019. The use of intra- or postoperative endoscopy for CBD clearance within 6 months after surgery was considered as failure of LCBDE. Predictors for the failure of LCBDE were investigated and outcomes were compared. RESULTS Among 222 operated patients, LCBDE was successfully performed in 173 patients (78%) and 49 (22%) required ERCP with sphincterotomy (intraoperative (n=29) or postoperative (n=20)). Independent risk factors for surgical failure were male sex (OR: 2.525 (1.111-5.738); p=0.027), anesthesia induction time ≥ 4 p.m. (OR: 4.858 (1.731-13.631); p=0.003), pediculitis (OR: 4.147 (1.177-14.606); p=0.027), and thin CDB < 4mm (OR: 11.951 (3.562-40.097), p< 0.0001). Age, ASA score, cystic anatomy, presence of cholecystitis, and the surgeon's experience were not identified as predictors for surgical failure. A general anesthesia number >1 (6% vs. 33%; p < 0.0001), length of initial stay (6 [1-42] vs. 8 [2-27], p=0.012), total length of hospitalization (6 [1-45] vs. 9 [2-27]; p=0.010), and the rate of emergency readmissions (3.5% vs. 12.2%; p=0.027) were significantly higher in the LCBDE failure group. CONCLUSIONS Upfront LCBDE for CBDS was associated with improved outcomes compared to intra-/postoperative ERCP recourse. Male sex, pediculitis, thin CBD, and surgery later than 4 p.m were associated with LCBDE failure and the need for endoscopic treatment. REGISTRATION NUMBER AND AGENCY The present retrospective study was approved by our local ethics committee and was declared on ClinicalTrials.gov (ID: NCT04467710).
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Affiliation(s)
- Diane Genet
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Régis Souche
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
| | - Simon Roucaute
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Frédéric Borie
- Digestive Surgery Department, Carémeau Hospital, University of Montpellier - Nîmes, Place du Professeur Debré, 30900, Nîmes, France
| | - Bertrand Millat
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Jean Christophe Valats
- Department of Gastroenterology, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Jean-Michel Fabre
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Astrid Herrero
- Digestive and Minimally Invasive Surgery Unit, Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, University of Montpellier - Nîmes, 80 Avenue Augustin Fliche, 34295, Montpellier, France
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Pavlidis ET, Pavlidis TE. Current management of concomitant cholelithiasis and common bile duct stones. World J Gastrointest Surg 2023; 15:169-176. [PMID: 36896310 PMCID: PMC9988640 DOI: 10.4240/wjgs.v15.i2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/27/2022] [Accepted: 01/17/2023] [Indexed: 02/27/2023] Open
Abstract
The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Stoyanova R, Lomoschitz F, Schima W, Klaus A. Minimally Invasive Approach for Complicated Choledocholithiasis in an Elderly Patient After Roux-Y Gastric Bypass. Obes Surg 2021; 31:3896-3898. [PMID: 34033010 DOI: 10.1007/s11695-021-05472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Gallstone disease after bariatric surgery is a common condition due to the obesity and rapid weight loss. Because of increasing obesity amongst the population, and the gastric bypass having been established as the standard treatment for morbid obesity, the occurrence of bile duct stones after this kind of surgery remains a therapeutic dilemma. We present a case of obstructed choledocholithiasis with shrinking of the gallbladder and consequent cholangitis in a 69-year-old Caucasian male patient after a laparoscopic Roux-and-Y gastric bypass (LRYGB), who underwent a successful laparoscopic single-stage bile stone removal of the choledochal duct using intraoperative ultrasound and choledochoscopy. There are several techniques to manage choledocholithiasis after LRYGB. Laparoscopic choledochoscopy with concomitant cholecystectomy after bariatric surgery can be a safe procedure even for elderly patients.
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Affiliation(s)
- Radoslava Stoyanova
- Department of Surgery, Barmherzige Schwestern Krankenhaus Wien, Stumpergasse 13, 1060, Vienna, Austria.
| | - Friedrich Lomoschitz
- Department of Diagnostic and Interventional Radiology, Klinik Hietzing, Wolkersbergenstrasse 1, 1130, Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Barmherzige Schwestern Krankenhaus Wien, Stumpergasse 13, 1060, Vienna, Austria
| | - Alexander Klaus
- Department of Surgery, Barmherzige Schwestern Krankenhaus Wien, Stumpergasse 13, 1060, Vienna, Austria
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Risk factors of recurrence following common bile duct exploration for choledocholithiasis. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:43-50. [PMID: 35601285 PMCID: PMC8965994 DOI: 10.7602/jmis.2021.24.1.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/06/2020] [Indexed: 01/19/2023]
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