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Lai W, Xu N. Feasibility and safety of choledochotomy primary closure in laparoscopic common bile duct exploration without biliary drainage: a retrospective study. Sci Rep 2023; 13:22473. [PMID: 38110402 PMCID: PMC10728103 DOI: 10.1038/s41598-023-49173-3] [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: 06/23/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
Common bile duct (CBD) exploration and T-tube drainage are the main surgical methods for the removal of bile duct stones (BDSs), which can now be completed by laparoscopy. However, the feasibility and safety of primary closure of the CBD (PCCBD) in laparoscopic CBD exploration (LCBDE) without biliary drainage are still uncertain. From January 1, 2021, to June 30, 2022, patients who were diagnosed with BDSs and underwent LCBDE and primary closure of the CBD without biliary drainage in our hospital were included. The clinical and prognostic data of the patients were retrospectively analyzed to determine the feasibility and safety of PCCBD in LCBDE without biliary drainage. Forty-nine patients successfully underwent PCCBD in LCBDE without biliary drainage. The operation time was 158.8 ± 50.3 (90-315,150) minutes, the bile duct suture time was 17.6 ± 4.46 (10-26, 18) minutes, the intraoperative blood loss volume was 70.4 ± 52.6 (5-200, 80) ml, the hospitalization cost was 28,141.2 ± 7011.3 (15,005.45-52,959.34, 26,815.14) CNY Yuan, the hospitalization time was 13.22 ± 5.16 (8-32, 12) days, and the postoperative hospitalization time was 7.31 ± 1.94 (3-15, 7) days. There were 3 cases of postoperative bile leakage (3/49, 6.12%), all of them healed by nonsurgical treatment. During the follow-up of 17.2 ± 11.01 (10-26, 17) months, no residual BDSs, biliary stricture or other complications classified as Clavien-Dindo grade I or higher occurred. For some selected patients who meet certain criteria, PCCBD in LCBDE without biliary drainage is feasible and safe and is more conducive to the rapid postoperative recovery of patients.
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Affiliation(s)
- Wei Lai
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People's Hospital (Chengdu Integrated TCM & Western Medicine Hospital), High Tech District, No. 18 Wanxiang North Road, Chengdu, 610044, Sichuan, People's Republic of China.
| | - Nan Xu
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People's Hospital (Chengdu Integrated TCM & Western Medicine Hospital), High Tech District, No. 18 Wanxiang North Road, Chengdu, 610044, Sichuan, People's Republic of China
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Jiang Y, Lu J, Li W, Zhang J, Li L. Primary closure after laparoscopic common bile duct exploration is safe and feasible for patients with non-severe acute cholangitis. Langenbecks Arch Surg 2022; 407:1553-1560. [PMID: 35562540 DOI: 10.1007/s00423-022-02547-z] [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: 12/06/2021] [Accepted: 05/08/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND The safety and feasibility of primary closure after laparoscopic common bile duct exploration (LCBDE) have been confirmed in elective settings. However, the suitability of primary closure after LCBDE in the treatment of patients with non-severe acute cholangitis in emergency settings remains unclear. The aim of the present study was to explore the safety and feasibility of LCBDE with primary closure in patients with non-severe acute cholangitis. METHODS Consecutive patients with choledocholithiasis combined with gallbladder stones treated by LCBDE with primary closure at our institution from January 2015 to April 2021 were retrospectively reviewed. These patients were divided into two groups: emergency group (patients with non-severe acute cholangitis) and elective group (patients without acute cholangitis). The demographic and perioperative data of the two groups were compared. RESULTS One hundred twenty-two patients received LCBDE combined with primary closure during this period, including 70 in the emergency group and 52 in the elective group. Baseline characteristics were balanced in both groups, except for higher levels of white blood cells (WBC), C-reactive protein (CRP), total bilirubin, alkaline phosphatase (ALP), and albumin in the emergency group. No postoperative mortality occurred in either group. Compared to the elective group, the emergency group had a longer operation time (P = 0.011), and more estimated blood loss (P < 0.001). No significant differences were found between the two groups in terms of conversion (2.9% vs. 0.0%, P = 0.507), use of baskets (84.2% vs. 78.8%, P = 0.481), use of electrohydraulic lithotripsy (EHL) (2.9% vs. 1.9%, P = 1.000), or postoperative hospital stay (P = 0.214). The incidence of postoperative complications was comparable between the two groups. During the follow-up period, none of the patients experienced biliary stricture, and 1 case of stone recurrence occurred in the elective group. CONCLUSIONS LCBDE with primary closure for choledocholithiasis patients with non-severe acute cholangitis has the equivalent efficacy and morbidity to elective surgery. Primary closure after LCBDE is a safe and feasible option for choledocholithiasis patients with non-severe acute cholangitis.
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Affiliation(s)
- You Jiang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Jun Lu
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Wenbo Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Jun Zhang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China
| | - Liang Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui Province, People's Republic of China.
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Jiang Y, Zhang J, Li W, Li L. Primary closure versus T-tube drainage after laparoscopic common bile duct exploration in patients with non-severe acute cholangitis. Updates Surg 2022; 74:899-906. [PMID: 34988916 DOI: 10.1007/s13304-021-01214-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/30/2021] [Indexed: 12/07/2022]
Abstract
Although the feasibility of T-tube drainage after emergency laparoscopic common bile duct exploration (LCBDE) has been reported, the safety and effectiveness of primary closure (PC) after LCBDE in patients with non-severe acute cholangitis (AC) remain uncertain. This study aimed to investigate the safety and feasibility of PC after LCBDE in patients with non-severe AC. Consecutive choledocholithiasis patients with non-severe AC who were treated with a laparoscopic approach at our institution between January 2014 and March 2021 were enrolled. These patients were divided into two groups (PC group and T-tube group) based on the way of closure of the common bile duct. The baseline characteristics and perioperative data between the two groups were compared. A total of 230 patients who underwent LCBDE met the inclusion criteria, and there were 94 patients in the PC group and 126 patients in the T-tube group. Baseline data were balanced between the two groups, except that there was less acute cholecystitis in the PC group than in the T-tube group (P = 0.027). Compared to the T-tube group, the PC group had a shorter operation time (P < 0.001), less estimated blood loss (P < 0.001), less use of electrohydraulic lithotripsy (EHL) (P = 0.001), shorter time of drainage removal (P < 0.001) and postoperative hospital stay (P < 0.001) and residual stones (P = 0.029). There was no significant difference between the two groups in terms of conversion (4.3 vs. 4.4%, P = 1.000), intraoperative transfusion (0.0 vs. 0.7%, P = 1.000), use of basket (71.2 vs. 69.9%, P = 0.816), postoperative bleeding (1.1 vs. 0.7%, P = 1.000), biliary leakage (4.3 vs. 3.7%, P = 1.000), incision infection (1.1 vs. 2.2%, P = 0.649), pneumonia (2.1 vs. 1.4%, P = 1.000), or cholangitis (1.1 vs. 2.9%, P = 0.651). No postoperative mortality occurred in either group. During the follow-up period, no biliary stricture occurred in the two groups, and two patients in the T-tube group were found to have stone recurrence. PC after LCBDE in choledocholithiasis patients with non-severe AC shows superior clinical outcomes to T-tube drainage in terms of the operation time, estimated blood loss, time of drainage removal, postoperative hospital stay, and residual stones. PC is a safe and feasible treatment for choledocholithiasis patients with non-severe AC after LCBDE.
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Affiliation(s)
- You Jiang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Jun Zhang
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Wenbo Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China
| | - Liang Li
- Department of General Surgery, Hefei Second People's Hospital, Anhui Medical University, Hefei, 230011, Anhui, People's Republic of China.
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Wang Y, Huang Y, Shi C, Wang L, Liu S, Zhang J, Wang W. Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones. Surg Endosc 2021; 36:4869-4877. [PMID: 34724579 PMCID: PMC9160116 DOI: 10.1007/s00464-021-08838-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/21/2021] [Indexed: 12/07/2022]
Abstract
Background T-tube drainage after laparoscopic common bile duct exploration (LCBDE) has been demonstrated to be safe and effective for patients with acute cholangitis caused by common bile duct stones (CBDSs). The outcomes after LCBDE with primary closure in patients with CBDS-related acute cholangitis are unknown. The present study aimed to evaluate the efficacy and safety of LCBDE with primary closure for the management of acute cholangitis caused by CBDSs. Methods Between June 2015 and June 2020, 368 consecutive patients with choledocholithiasis combined with cholecystolithiasis, who underwent laparoscopic cholecystectomy (LC) + LCBDE in our department, were retrospectively reviewed. A total of 193 patients with CBDS-related acute cholangitis underwent LC + LCBDE with primary closure of the CBD (PC group) and 62 patients underwent LC + LCBDE followed by T-tube placement (T-tube group). A total of 113 patients who did not have cholangitis were excluded. The clinical data were compared and analyzed. Results There was no mortality in either group. No significant differences were noted in morbidity, bile leakage rate, retained CBD stones, or readmission rate within 30 days between the two groups. Compared with the T-tube group, the PC group avoided T-tube-related complications and had a shorter operative time (121.12 min vs. 143.37 min) and length of postoperative hospital stay (6.59 days vs. 8.81 days). Moreover, the hospital expenses in the PC group were significantly lower than those in the T-tube group ($4844.47 vs. $5717.22). No biliary stricture occurred during a median follow-up of 18 months in any patient. No significant difference between the two groups was observed in the rate of stone recurrence. Conclusions LCBDE with primary closure is a safe and effective treatment for cholangitis caused by CBDSs. LCBDE with primary closure is not inferior to T-tube drainage for the management of CBDS-related acute cholangitis in suitable patients.
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Affiliation(s)
- Yanjun Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Youbao Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Chunfeng Shi
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Linpei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Shengwei Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Jiawei Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Wei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China.
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Xu B, Luo T, Yang T, Wang S, Meng H, Gong J, Zhou B, Zheng W, Song Z. Laparoscopic common bile duct exploration with primary closure is beneficial for patients with previous upper abdominal surgery. Surg Endosc 2021; 36:1053-1063. [PMID: 33650005 DOI: 10.1007/s00464-021-08371-8] [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: 10/14/2020] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous upper abdominal surgery (PUAS) is considered a contraindication to laparoscopic surgery. Whether LCBDE-PC is feasible and beneficial for patients with PUAS remains unclear. This study aimed to evaluate the feasibility and benefits of LCBDE-PC for patients with PUAS. METHODS From June 2011 to September 2019, 1167 patients who underwent laparoscopic procedures for choledocholithiasis were reviewed retrospectively. Perioperative outcomes were compared between patients with and without PUAS in un-matched and matched cohorts. RESULTS LCBDE-PC was performed successfully in 88.3% of patients with PUAS, and 92.5% of patients without PUAS (P > 0.05). Multivariate analysis showed that PUAS was not a risk factor that affected successful performance of LCBDE-PC. Although a higher rate of conversion to open surgery and longer operative time were observed in patients with PUAS, no significant differences were found between patients with and without PUAS in multivariate and propensity score analysis (P > 0.05). A predictive nomogram for LCBDE-PC failure was developed based on potential predictors from the least absolute shrinkage and selection operator (LASSO) regression model. Successful performance of LCBDE-PC was associated with operative time. A linear regression model for operative time showed impacted stone in the CBD and intraoperative laser use was the most important factor in determining the operative time. CONCLUSION LCBDE-PC is feasible and beneficial for patients with PUAS. However, patients with PUAS with a high possibility of LCBDE-PC failure from the nomogram and a longer operative time from the linear regression model should be cautious when undergoing LCBDE-PC.
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Affiliation(s)
- Bin Xu
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| | - Tingyi Luo
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Tingsong Yang
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shilin Wang
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Hongbo Meng
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Jian Gong
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Bo Zhou
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Wenyan Zheng
- Department of Surgical Intensive Care Unit, Zhong Shan Hospital, Fudan University, Shanghai, 200232, China.
| | - Zhenshun Song
- Department of General Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Olausson M, Westen M, Boilesen AEB, Shabanzadeh DM. Laparoscopic Common Bile Duct Exploration for Common Bile Duct Stones Complicated with Cholangitis in Patients with Roux-en-Y Gastric Bypass-Clinical Experience from Three Cases. Obes Surg 2020; 30:5142-5144. [PMID: 32839932 DOI: 10.1007/s11695-020-04947-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Maria Olausson
- Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mikkel Westen
- Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Astrid E B Boilesen
- Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Daniel M Shabanzadeh
- Department of Gastroenterology, Surgical Unit, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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Abstract
Gallstone disease is a common and frequently occurring disease in human, and it is the main disease among the digestive system diseases. The incidence of gallstone disease in western countries is about 5%-22%, and common bile duct stones (CBDS) accounts for 8%-20%. CBDS easily lead to biliary obstruction, secondary cholangitis, pancreatitis, and obstructive jaundice, even endanger life. Therefore, it needs timely treatment once diagnosed. The recurrence of choledocholithiasis after bile duct stones clearance involves complicated factors and cannot be completely elaborated by a single factor. The risk factors for recurrence of choledocholithiasis include bacteria, biliary structure, endoscopic and surgical treatment, and inflammation. The modalities for management of choledocholithiasis are endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic or open common bile duct exploration, dissolving solutions, extracorporeal shockwave lithotripsy (ESWL), percutaneous radiological interventions, electrohydraulic lithotripsy (EHL) and laser lithotripsy. We compare the different benefits between surgery and ERCP. And finally, we make a summary of the current strategy for reducing the recurrence of CBDS and future perspectives for CBDS management.
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Affiliation(s)
| | - Sun Qiang
- b Department of General Surgery , Jing'an District Center Hospital of Shanghai (Huashan Hospital Fudan University Jing'an Branch) , Shanghai , PR China
| | - Yin Bao-Bing
- c Department of General Surgery , Huashan Hospital, Fudan University , Shanghai , PR China
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El Nakeeb A, El Geidie A, El Hanafy E, Atef E, Askar W, Sultan AM, Hamdy E, El Shobary M, Hamed H, Abdelrafee A, Zeid MA. Management and Outcome of Borderline Common Bile Duct with Stones: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2016; 26:161-7. [PMID: 26828596 DOI: 10.1089/lap.2015.0493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Management of common bile duct stones (CBDS) in patients with borderline CBD presents a surgical challenge. The aim of this study was to compare conservative treatment with endoscopic stone extraction for the treatment of borderline CBD with stones. PATIENTS AND METHODS This prospective randomized controlled trial includes patients with CBDS in borderline CBD (CBD <10 mm) associated with gallbladder stones who were treated with conservative treatment or endoscopic stone extraction followed by laparoscopic cholecystectomy (LC) and intraoperative cholangiogram (IOC). The primary outcome was successful CBD clearance. The secondary outcomes were the overall complications, cost, and hospital stay. RESULTS LC and IOC revealed complete clearance of CBDS in 48 (96%) cases in the endoscopic retrograde cholangiopancreatography (ERCP) group (52% of patients by ERCP, and 44% of patient passed the stone spontaneously), and in the remaining two patients, the CBDS was removed by transcystic exploration. In the conservative group, LC and IOC revealed complete clearance of CBDS in 90% of cases, and in the remaining 10% of patients, the CBDS was removed by transcystic exploration. Post-ERCP pancreatitis (PEP) is noticed significantly in the ERCP group (2 [4%] versus 8 [16%]; P = .04). The average net cost was significantly higher in the ERCP group. Recurrent biliary symptoms developed significantly in the ERCP group after 1 year (10% versus 0%; P = .02) in the form of recurrent cholangititis and recurrent CBDS. CONCLUSIONS Management of CBDS in patients with borderline CBD represents a surgical challenge. Borderline CBD increases the technical difficulty of ERCP and increases the risk of PEP. Conservative management of CBDS in borderline CBD not only avoids the risks inherent in ERCP and unnecessary preoperative ERCP, but it is also effective in clearing CBDS. The hepatobiliary surgeon should consider a conservative line of treatment in CBDS in borderline CBD in order to decrease the cost and avoid unnecessary ERCP.
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Affiliation(s)
- Ayman El Nakeeb
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Ahmed El Geidie
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Ehab El Hanafy
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Ehab Atef
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Waleed Askar
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Ahmad M Sultan
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Emad Hamdy
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | | | - Hosam Hamed
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Ahmed Abdelrafee
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
| | - Mostafa Abu Zeid
- Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt
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Zhu B, Li D, Ren Y, Li Y, Wang Y, Li K, Amin B, Gong K, Lu Y, Song M, Zhang N. Early versus delayed laparoscopic common bile duct exploration for common bile duct stone-related nonsevere acute cholangitis. Sci Rep 2015; 5:11748. [PMID: 26123122 PMCID: PMC4485235 DOI: 10.1038/srep11748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/04/2015] [Indexed: 02/06/2023] Open
Abstract
It is undetermined when and how laparoscopic common bile duct exploration (LCBDE) should be used in patients with common bile duct (CBD) stone-related nonsevere acute cholangitis. We aimed to evaluate the effect of LCBDE on the clinical outcome of those patients within (early) or beyond (delayed) 72 hours of emergent admission. Surgery-related complications, length of hospital stay (LOS), and total cost, as well as demographic and clinical parameters were compared between the two groups. Finally, 3 and 5 patients in early and delayed LCBDE group, respectively, had retained stones, which were removed by choledochoscopy before T-tube was removed. Each group had 3 patients who developed biliary leak, which was conservatively cured by the drainage. Shorter LOS and less total cost were observed in early group compared to the late one (13.34 ± 4.48 vs. 18.32 ± 9.13, p < 0.05; 17712 ± 5446.63 vs. 21776 ± 7230.41 ¥RMB, p < 0.05). Improvement of cholangitis was achieved in all patients with LCBDE. None of the patients developed stricture of the CBD after LCBDE. To conclude, both early and delayed LCBDE are safe and effective for the treatment of CBD stone-related nonsevere acute cholangitis during emergent admissions. Early LCBDE may be superior to delayed procedure due to the shorter LOS and less cost.
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Affiliation(s)
- Bin Zhu
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Dan Li
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Yu Ren
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Ying Li
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Yan Wang
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Kai Li
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Buhe Amin
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Ke Gong
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Yiping Lu
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
| | - Ming Song
- Department of medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky, US
| | - Nengwei Zhang
- Laparoscopic Surgical Center, Department of General Surgery of Beijing Shijitan Hospital, Capital Medical University. Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, P.R. China
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10
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Laparoscopic cholecystectomy and choledocolithotomy with primary suture for lithiasis (with video). J Visc Surg 2015; 152:133-4. [PMID: 25748695 DOI: 10.1016/j.jviscsurg.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hua J, Lin S, Qian D, He Z, Zhang T, Song Z. Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg 2015; 32:1-8. [PMID: 25613528 DOI: 10.1159/000368326] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Choledocholithiasis is traditionally managed by endoscopic retrograde cholangiopancreatography or T-tube insertion following common bile duct exploration. This study examined the efficacy and safety of primary duct closure following laparoscopic common bile duct exploration (LCBDE) via choledochotomy. METHODS Between September 2011 and September 2013, 157 consecutive patients underwent LCBDE via choledochotomy. RESULTS Of 157 LCBDE procedures, 138 (87.9%) were successfully completed with primary closure of the choledochotomy. Eight patients (5.1%) underwent closure with T-tube drainage after choledochotomy and 11 patients (7.0%) were converted to open surgery. The biliary tree was free of stones at the end of surgery in 154 patients (98.1%). Postoperative bile leak occurred in 6 patients (3.8%). The median follow-up period was 18 (2-33) months, with no evidence of further bile duct stones or bile duct stricture in any patients. Univariable analysis revealed that successful duct clearance (p = 0.010) and diameter of the common bile duct (p < 0.001) were two significant risk factors for bile leak. CONCLUSIONS Primary duct closure following LCBDE is effective and safe for the management of choledocholithiasis. The postoperative bile leak rate may be low in skilled laparoscopic surgeons with a careful selection of patients.
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Affiliation(s)
- Jie Hua
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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El Nakeeb A, Sultan AM, Hamdy E, El Hanafy E, Atef E, Salah T, El Geidie AA, Kandil T, El Shobari M, El Ebidy G. Intraoperative endoscopic retrograde cholangio-pancreatography: A useful tool in the hands of the hepatobiliary surgeon. World J Gastroenterol 2015; 21:609-615. [PMID: 25605984 PMCID: PMC4296022 DOI: 10.3748/wjg.v21.i2.609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 06/22/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of intraoperative endoscopic retrograde cholangio-pancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) for patients with gall bladder stones (GS) and common bile duct stones (CBDS).
METHODS: Patients treated for GS with CBDS were included. LC and intraoperative transcystic cholangiogram (TCC) were performed in most of the cases. Intraoperative ERCP was done for cases with proven CBDS.
RESULTS: Eighty patients who had GS with CBDS were included. LC was successful in all cases. Intraoperative TCC revealed passed CBD stones in 4 cases so intraoperative ERCP was performed only in 76 patients. Intraoperative ERCP showed dilated CBD with stones in 64 cases (84.2%) where removal of stones were successful; passed stones in 6 cases (7.9%); short lower end stricture with small stones present in two cases (2.6%) which were treated by removal of stones with stent insertion; long stricture lower 1/3 CBD in one case (1.3%) which was treated by open hepaticojejunostomy; and one case (1.3%) was proved to be ampullary carcinoma and whipple’s operation was scheduled.
CONCLUSION: The hepatobiliary surgeon should be trained on ERCP as the third hand to expand his field of therapeutic options.
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Haghparast-Bidgoli H, Kiadaliri AA, Skordis-Worrall J. Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:15. [PMID: 25050084 PMCID: PMC4105166 DOI: 10.1186/1478-7547-12-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 06/28/2014] [Indexed: 11/10/2022] Open
Abstract
To aid informed health sector decision-making, data from sufficient high quality economic evaluations must be available to policy makers. To date, no known study has analysed the quantity and quality of available Iranian economic evaluation studies. This study aimed to assess the quantity, quality and targeting of economic evaluation studies conducted in the Iranian context. The study systematically reviewed full economic evaluation studies (n = 30) published between 1999 and 2012 in international and local journals. The findings of the review indicate that although the literature on economic evaluation in Iran is growing, these evaluations were of poor quality and suffer from several major methodological flaws. Furthermore, the review reveals that economic evaluation studies have not addressed the major health problems in Iran. While the availability of evidence is no guarantee that it will be used to aid decision-making, the absence of evidence will certainly preclude its use. Considering the deficiencies in the data identified by this review, current economic evaluations cannot be a useful source of information for decision makers in Iran. To improve the quality and overall usefulness of economic evaluations we would recommend; 1) developing clear national guidelines for the conduct of economic evaluations, 2) highlighting priority areas where information from such studies would be most useful and 3) training researchers and policy makers in the calculation and use of economic evaluation data.
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Affiliation(s)
| | - Aliasghar Ahmad Kiadaliri
- Health Economics Unit, Department of Clinical Sciences-Malmö, Lund University, Lund, Sweden ; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jolene Skordis-Worrall
- Institute for Global Health, University College London, London, UK ; Department for Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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14
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Zhu B, Wang Y, Gong K, Lu Y, Ren Y, Hou X, Song M, Zhang N. Comparison of emergent versus elective laparoscopic common bile duct exploration for patients with or without nonsevere acute cholangitis complicated with common bile duct stones. J Surg Res 2013; 187:72-6. [PMID: 24398306 DOI: 10.1016/j.jss.2013.11.1115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 11/14/2013] [Accepted: 11/27/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) has already been established for the treatment of patients with common bile duct stones (CBDS) in elective situations. However, the effect of emergent LCBDE on those patients with nonsevere acute cholangitis has not been assessed. The aim of this study was to evaluate the effect of emergent LCBDE on patients with nonsevere acute cholangitis complicated with CBDS. METHODS Seventy-two patients with CBDS admitted from January 2009 to December 2012 were included for this retrospective study. LCBDE of transductal approach for CBDS was performed to all patients. Thirty-seven patients underwent emergent LCBDE for nonsevere acute cholangitis and 35 patients underwent elective LCBDE. Duration of the procedure, complications, retained stone of bile duct, hospital stay, and total charges were compared between the two groups. In addition, the characteristics of patients underwent emergent LCBDE were also compared before and after surgery. RESULTS There was no significant difference with regard to the diameter of common bile duct and number of CBDS from imaging and/or operative findings between the two groups. There was no conversion to open common bile duct exploration, no major bile duct injuries, and no mortality in both the group of patients. There was no significant difference in patients with or without acute or chronic cholecystitis, duration of surgery, overall hospital stay (16.41 ± 1.03 versus 14.54 ± 0.94, P > 0.05), and total charges (18,603 ± 1774.64 versus 14,951 ± 1257.09 Yuan in renminbi, P > 0.05) between the two groups. Four cases with retained stones were found in patients with emergent LCBDE and two in elective LCBDE patients. There were four cases of biliary leak in patients with emergent LCBDE and three cases in elective LCBDE group, respectively. However, there was no statistical difference between the two groups. The biliary leak was cured postoperatively after drainage. Control of septic symptoms was achieved in all patients after emergent LCBDE. CONCLUSIONS Our data indicated that emergent LCBDE is as safe and effective as elective LCBDE for the treatment of patients with nonsevere acute cholangitis complicated with CBDS.
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Affiliation(s)
- Bin Zhu
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
| | - Yan Wang
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Ke Gong
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yiping Lu
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Yu Ren
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Xiaopu Hou
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Ming Song
- Department of medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Louisville, Kentucky
| | - Nengwei Zhang
- Department of General Surgery, Laparoscopic Surgical Center, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China.
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Ding YB, Deng B, Liu XN, Wu J, Xiao WM, Wang YZ, Ma JM, Li Q, Ju ZS. Synchronous vs sequential laparoscopic cholecystectomy for cholecystocholedocholithiasis. World J Gastroenterol 2013; 19:2080-2086. [PMID: 23599628 PMCID: PMC3623986 DOI: 10.3748/wjg.v19.i13.2080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/04/2013] [Accepted: 01/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare synchronous laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) and sequential LC combined with EST for treating cholecystocholedocholithiasis.
METHODS: A total of 150 patients were included and retrospectively studied. Among these, 70 were selected for the synchronous operation, in which the scheme was endoscopic retrograde cholangiopancreatography combined with EST during LC. The other 80 patients were selected for the sequential operation, in which the scheme involved first cutting the papillary muscle under endoscopy and then performing LC. The indexes in the two groups, including the operation time, the success rate, the incidence of complications, and the length of the hospital stay, were observed.
RESULTS: There were no significant differences between the groups in terms of the numbers of patients, sex distribution, age, American Society of Anesthesiologists score, serum bilirubin, γ-glutamyl transpeptidase, mean diameter of common bile duct stones, and previous medical and surgical history (P = 0.54, P = 0.18, P = 0.52, P = 0.22, P = 0.32, P = 0.42, P = 0.68, P = 0.70, P = 0.47 and P = 0.57). There was no significant difference in the surgical operation time between the two groups (112.1 ± 30.8 min vs 104.9 ± 18.2 min). Compared with the sequential operation group, the incidence of pancreatitis was lower (1.4% vs 6.3%), the incidence of hyperamylasemia (1.4% vs 10.0%, P < 0.05) was significantly reduced, and the length of the hospital stay was significantly shortened in the synchronous operation group (3 d vs 4.5 d, P < 0.001).
CONCLUSION: For treatment of cholecystocholedocholithiasis, synchronous LC combined with EST reduces incidence of complications, decreases length of hospital stay, simplifies the surgical procedure, and reduces operation time.
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Tommasi C, Bencini L, Bernini M, Naspetti R, Cavallina G, Manetti R, Talamucci L, Farsi M. Routine Use of Simultaneous Laparoendoscopic Approach in Patients with Confirmed Gallbladder and Bile Duct Stones: Fit for Laparoscopy Fit for “Rendezvous”. World J Surg 2013; 37:999-1005. [DOI: 10.1007/s00268-013-1962-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc 2010; 25:1230-7. [PMID: 20844893 DOI: 10.1007/s00464-010-1348-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 08/23/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND ERCP remains the prevailing method of treating CBDS; however, its ideal timing in respect to laparoscopic cholecystectomy (LC) is not defined. LC combined with intraoperative endoscopic sphincterotomy (IOES) was compared with preoperative endoscopic sphincterotomy (PES) followed by LC for management of preoperatively known cholecystocholedocholithiasis. METHODS Between June 2006 and September 2009, 198 patients diagnosed preoperatively by clinical assessment, liver chemistry, ultrasonography, and magnetic resonance cholangiopancreatography (MRCP) to have combined choledochocystolithiasis were eligible. They were randomly divided into two groups: PES/LC group (n = 100) and LC/IOES group (n = 98). The surgical times, surgical success rates, number of stone extractions, postoperative complications, retained common bile duct stones, and postoperative lengths of stay were compared prospectively. RESULTS There were no statistically significant differences in surgical time, surgical success rate, CBD diameter, stone size, or stone number between the two groups. The success rate was 95.3% and 97.8% for PES/LC and LC/IOES, respectively. There were no significant difference in postoperative retained stones, surgical time, and complications, but the total hospital stay was significantly shorter in the LC/IOES group. CONCLUSIONS PES/LC and LC/IOES are both good options for dealing with preoperatively diagnosed CBDS, but when there is enough experience and facilities, LC/IOES, as a single-stage treatment, would be preferable.
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Chalkoo M, Masoodi I, Hussain S, Chalkoo S, Farooq O. Laparoscopic exploration of the common bile duct and removal of dead worm in a patient of cholangitis after endoscopic retrograde cholangiopancreatography failure. J Minim Access Surg 2009; 5:82-4. [PMID: 20040804 PMCID: PMC2822177 DOI: 10.4103/0972-9941.58504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We describe a dead ascaris-induced extrahepatic bilary obstruction in a young female who presented with acute cholangitis. The dead ascaris was removed by laparoscopic exploration of common bile duct after endoscopic retrograde cholangiopancreatography failure. Patient had an uneventful hospital course after the procedure and was discharged afebrile after 3 days of hospital stay.
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Affiliation(s)
- Mushtaq Chalkoo
- Department of Surgery, Government Medical College, SMHS and Associated Hospitals, Srinagar, Jammu and Kashmir, State, India
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Gholipour C, Fakhree MBA, Shalchi RA, Abbasi M. Prediction of conversion of laparoscopic cholecystectomy to open surgery with artificial neural networks. BMC Surg 2009; 9:13. [PMID: 19698100 PMCID: PMC2745364 DOI: 10.1186/1471-2482-9-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 08/21/2009] [Indexed: 01/02/2023] Open
Abstract
Background The intent of this study was to predict conversion of laparoscopic cholecystectomy (LC) to open surgery employing artificial neural networks (ANN). Methods The retrospective data of 793 patients who underwent LC in a teaching university hospital from 1997 to 2004 was collected. We employed linear discrimination analysis and ANN models to examine the predictability of the conversion. The models were validated using prospective data of 100 patients who underwent LC at the same hospital. Results The overall conversion rate was 9%. Conversion correlated with experience of surgeons, emergency LC, previous abdominal surgery, fever, leukocytosis, elevated bilirubin and alkaline phosphatase levels, and ultrasonographic detection of common bile duct stones. In the validation group, discriminant analysis formula diagnosed the conversion in 5 cases out of 9 (sensitivity: 56%; specificity: 82%); the ANN model diagnosed 6 cases (sensitivity: 67%; specificity: 99%). Conclusion The conversion of LC to open surgery is effectively predictable based on the preoperative health characteristics of patients using ANN.
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Affiliation(s)
- Changiz Gholipour
- Department of General Surgery, Sinaea Hospital, Tabriz University of Medical Sciences Tabriz, Iran.
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Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract 2009; 2009:840208. [PMID: 19672460 PMCID: PMC2722154 DOI: 10.1155/2009/840208] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/25/2009] [Indexed: 02/08/2023] Open
Abstract
Common bile duct stones (CBDSs) may occur in up to 3%–14.7% of all patients for whom cholecystectomy is preformed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also differing treatments. Different methods have been used for the treatment of CBDS but the suitable therapy depends on conditions such as patient' satisfaction, number and size of stones, and the surgeons experience in laparoscopy. Endoscopic retrograde cholangiopancreatography with or without endoscopic biliary sphincterotomy, laparoscopic CBD exploration (transcystic or transcholedochal), or laparotomy with CBD exploration (by T-tube, C-tube insertion, or primary closure) are the most commonly used methods managing CBDS. We will review the pathophysiology of CBDS, diagnosis, and different techniques of treatment with especial focus on the various surgical modalities.
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Li LB, Cai XJ, Mou YP, Wei Q. Reoperation of biliary tract by laparoscopy: Experiences with 39 cases. World J Gastroenterol 2008; 14:3081-4. [PMID: 18494063 PMCID: PMC2712179 DOI: 10.3748/wjg.14.3081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the safety and feasibility of biliary tract reoperation by laparoscopy for the patients with retained or recurrent stones who failed in endoscopic sphincterotomy.
METHODS: A retrospective analysis of data obtained from attempted laparoscopic reoperation for 39 patients in a single institution was performed, examining open conversion rates, operative times, complications, and hospital stay.
RESULTS: Out of the 39 cases, 38 (97%) completed laparoscopy, 1 required conversion to open operation because of difficulty in exposing the common bile duct. The mean operative time was 135 min. The mean post-operative hospital stay was 4 d. Procedures included laparoscopic residual gallbladder resection in 3 cases, laparoscopic common bile duct exploration and primary duct closure at choledochotomy in 13 cases, and laparoscopic common bile duct exploration and choledochotomy with T tube drainage in 22 cases. Duodenal perforation occurred in 1 case during dissection and was repaired laparoscopically. Retained stones were found in 2 cases. Postoperative asymptomatic hyperamylasemia occurred in 3 cases. There were no complications due to port placement, postoperative bleeding, bile or bowel leakage and mortality. No recurrence or formation of duct stricture was observed during a mean follow-up period of 18 mo.
CONCLUSION: Laparoscopic biliary tract reoperation is safe and feasible if it is performed by experienced laparoscopic surgeons, and is an alternative choice for patients with choledocholithiasis who fail in endoscopic sphincterectomy.
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