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Mehendale VG, Kamdar MS, Shenoy SN. Pragmatic algorithm for management of common bile duct calculi in resource-limited settings in India. J Minim Access Surg 2024:01413045-990000000-00044. [PMID: 38557406 DOI: 10.4103/jmas.jmas_293_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) facilitates the removal of common bile duct (CBD) calculi by endoscopy. When ERCP fails, exploration of CBD is required for the clearance of CBD calculi. The optimum way for the exploration of CBD is by choledochoscopy. Dedicated flexible or rigid choledochoscopes are expensive and available only in few places in India. Since 1991, we subjected patients with suspected CBD calculi to ERCP, followed by laparoscopic cholecystectomy (LC). Patients in whom ERCP failed to clear CBD were subjected to open exploration of CBD using any easily available, suitable, straight rigid scope for choledochoscopy. PATIENTS AND METHODS Since March 1991, out of 8866 patients with cholelithiasis, 862 underwent ERCP. Ninety-six patients in whom ERCP failed to clear CBD underwent open exploration of CBD. In each case of exploration of CBD, choledochoscopy was performed using a straight rigid scope, either a cystoscope, paediatric cystoscope, hysteroscope or 5-mm laparoscopy telescope with a 5-mm cannula. RESULTS The CBD clearance was complete in 95 patients, and one patient had an impacted calculus at the ampulla. CBD explorations were followed by choledochoduodenostomy, T-tube placement or suturing of choledochotomy. No residual calculi were observed after such exploration. CONCLUSION From our results, we advocate the following algorithm for CBD calculi in resource-limited settings. Subject patients with CBD calculi to ERCP followed by LC. In case of failed ERCP, open exploration of CBD with choledochoscopy using any suitable rigid scope. Dedicated flexible or rigid choledochoscope is not essential. This approach is cost-effective and successful.
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Affiliation(s)
| | - Manoj S Kamdar
- Medico Surgical Clinic and Hospital, Seth VC Gandhi and MA Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sharad Narayan Shenoy
- Medico Surgical Clinic and Hospital, Seth VC Gandhi and MA Vora Municipal General Hospital, Mumbai, Maharashtra, India
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Common Bile Duct Pathology — Scope of Laparoscopy Illustrated Case Series Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee SJ, Choi IS, Moon JI, Choi YW. Optimal treatment for concomitant gallbladder stones with common bile duct stones and predictors for recurrence of common bile duct stones. Surg Endosc 2021; 36:4748-4756. [PMID: 34734299 DOI: 10.1007/s00464-021-08815-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/17/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal treatment for concomitant gallbladder (GB) stones with common bile duct (CBD) stones and predictors for recurrence of CBD stones are not established. METHODS This single-center, retrospective study reviewed 466 patients diagnosed with a first event of concomitant GB stones with CBD stones from January 2010 to December 2018. RESULTS 92 patients underwent single-stage laparoscopic CBD exploration (LCBDE) and laparoscopic cholecystectomy (LC) (group1), 108 underwent LCBDE + LC after endoscopic stone extraction (ESE) failure (group2), and 266 underwent ESE + LC (group3). Clearance (95.7 vs. 99.1 vs. 97.0%, p = 0.324) and recurrence rates (5.4 vs. 13.0 vs. 7.9%, p = 0.138) did not differ between groups. Group1 had fewer procedures (p < 0.001), lower post-treatment complication rates (7.6 vs. 18.5 vs. 13.9%, p = 0.082), and shorter hospital stay after the first procedure (5.7 vs 13.0 vs 9.8 days, p < 0.001). 40 patients (8.6%) had recurrence of CBD stones at mean follow-up of 17.1 months, of which 29 (72.5%) occurred within 24 months. In multivariate analysis, a CBD diameter > 8 mm, combined type-1 periampullary diverticulum, and age > 70 years were significant predictors of recurrence. CONCLUSION Single-stage LCBDE + LC is a safe and effective treatment for concomitant GB stones with CBD stones compared to ESE + LC. LCBDE should be considered in patients with a high risk of ESE failure. Careful follow-up is recommended for patients at high risk of recurrence of CBD stones, especially within 24 months after surgical or endoscopic treatment.
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Affiliation(s)
- Seung Jae Lee
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - In Seok Choi
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea.
| | - Ju Ik Moon
- Department of Surgery, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - Yong Woo Choi
- Department of Internal Medicine, Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Zhu J, Zhang Y, Du P, Hu W, Xiao W, Li Y. Systematic Review and Meta-analysis of Laparoscopic Common Bile Duct Exploration in Patients With Previous Failed Endoscopic Retrograde Cholangiopancreatography. Surg Laparosc Endosc Percutan Tech 2021; 31:654-662. [PMID: 33973942 DOI: 10.1097/sle.0000000000000949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim was to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (group A) versus primary LCBDE (group B) for the management of gallbladder and common bile duct stones. MATERIALS AND METHODS A comprehensive and systematic literature search was performed in several databases, including PubMed, Ovid, and Cochrane Library. Meta-analysis of operative outcomes, postoperative outcomes, and gallstone clearance rates was conducted using random-effect models. RESULTS Six studies including 642 patients (239 in group A and 403 in group B) were included. The operative time was longer in group A (P=0.02). The overall complication, bile leakage, conversion, postoperative hospital stay, and reoperation were comparable in group A and group B. Similarly, no significant difference was present concerning the incidence of stone clearance, residual stone, and recurrent stone (P>0.05). CONCLUSION LCBDE is an alternative acceptable procedure when removal of common bile duct stones by endoscopic therapy fails.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Paik KY, Oh JS, Kim EK. Appraisal of Laparoscopic Common Bile Duct Explorations Using Balloon-Assisted Stone Extraction Method: Seventeen Years Experiences. J Laparoendosc Adv Surg Tech A 2020; 31:326-330. [PMID: 32706645 DOI: 10.1089/lap.2020.0414] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Balloon-assisted stone extraction (BASE) can be applied to remove the common bile duct (CBD) stones during laparoscopic CBD exploration (LCBDE). This study aimed to analyze the efficacy of BASE. Methods: A retrospective analysis of patients with CBD stone who underwent LCBDE using BASE from 2001 to 2017 was conducted. The outcomes of BASE and potential factor for failure of technique were also evaluated. Results: A total of 163 patients underwent LCBDE using BASE were enrolled. Success rate of BASE was 88.3% (144/163) and 19 (11.7%) patients with failed BASE underwent basket for lithotripsy additionally. The reason for aborting BASE were stone impaction (n = 6), small stone (n = 4), migration into intrahepatic duct (IHD) (n = 3), and others (n = 6). The overall success rate of stone clearance was 98.2% (160/163). The mean CBD diameter was 15.8 mm (range 7-34 mm), and the largest stone size was 13.8 mm (range 3-36 mm). The overall rate of complication related with procedure was 4.9% (8/163), including bile leakage in 2 patients (1.2%), bleeding in 2 patients (1.2%), and pancreatitis in 4 patients (2.4%). There was no procedure-related mortality. Conclusions: BASE for CBD stone is safe and effective technique for the treatment of CBD stones.
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Affiliation(s)
- Kwang Yeol Paik
- Department of Surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Seon Oh
- Department of Surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eung Kook Kim
- Department of Surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Long-term Outcomes Following Primary Closure of Common Bile Duct Following Laparoscopic Common Bile Duct (CBD) Exploration: Experience of 355 Cases at a Tertiary Care Center. Surg Laparosc Endosc Percutan Tech 2020; 30:504-507. [DOI: 10.1097/sle.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Di Mauro D, Ricciardi E, Siragusa L, Manzelli A. Outcome of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography: A Comparative Study. J Laparoendosc Adv Surg Tech A 2019; 29:1391-1396. [DOI: 10.1089/lap.2019.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Davide Di Mauro
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Edoardo Ricciardi
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Manzelli
- Department of Upper GI Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
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Jia B, Jin Z, Han W, Liu Y. Safety and efficacy of emergency laparoscopic common bile duct exploration in elderly patients with complicated acute cholangitis. Surg Endosc 2019; 34:1330-1335. [PMID: 31209606 PMCID: PMC7012973 DOI: 10.1007/s00464-019-06914-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/11/2019] [Indexed: 01/13/2023]
Abstract
Background Acute cholangitis (AC) is an acute inflammation of the biliary tract caused by bacterial infection, which occurs due to biliary obstruction primarily because of bile duct stones. We aimed to study the effect of laparoscopic common bile duct exploration in the treatment of complicated AC for elderly patients. Method Elderly patients with complicated AC admitted to our hospital from August 2014 to August 2018 were considered. According to the patients’ general conditions and the American Society of Anesthesiologists’ (ASA) grade, 98 patients were divided into three groups: ASA grade II, 38 patients; ASA grade III, 33 patients; and ASA grade IV, 27 patients; all patients underwent emergency laparoscopic common bile duct exploration within 8 h of admission. The perioperative data of these patients were analyzed. Results There were no significant differences between the three groups in preoperative laboratory test results, except for albumin levels. Conversely, when compared in every group, there were some significant differences in changes between pre- and postoperative laboratory test results, except for albumin levels. There were no significant differences between the groups in terms of perioperative data (operation time, blood loss, peritoneal drainage time, postoperative time to flatus, and postoperative hospital stay). Although four patients had postoperative complications, there were no significant differences in the rate of complications between the groups. Conclusion Laparoscopic common bile duct exploration is a safe, effective, and feasible method for treating complicated AC in elderly patients. It should be actively used in clinical work to rapidly relieve biliary obstruction.
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Affiliation(s)
- Baoxing Jia
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, NO. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Zhe Jin
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, NO. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Wei Han
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, NO. 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital of Jilin University, NO. 71 Xinmin Street, Changchun, 130021, Jilin, China.
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Muhammedoğlu B. Single-stage treatment with ERCP and laparoscopic cholecystectomy versus two-stage treatment with ERCP followed by laparoscopic cholecystectomy within six to eight weeks: a retrospective study. Turk J Surg 2019; 35:178-184. [PMID: 32550325 DOI: 10.5152/turkjsurg.2018.4204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 01/11/2023]
Abstract
Objectives Obstructive jaundice is one of the earliest symptoms of a hepatobiliary system disorder. The aim of the present study was to compare single stage endoscopic retrograde cholangiopancreatography (ERCP)/laparoscopic cholecystectomy (LC) and two-stage ERCP and LC with respect to the frequency of imaging, duration of anesthesia and the length of stay in our clinic. Material and Methods Of the 350 patients undergoing ERCP between 01.01.2015 and 31.12.2016, 31 patients with single-stage ERCP and LC were assigned to Group A and 25 patients with two-stage ERCP followed by LC within 6-8 weeks were assigned to Group B. Eligibility criteria included ERCP duration, difficulty of the procedure, bile duct stones as demonstrated by imaging methods, no contraindications for LC and no suspected or known malignancy. The same surgeon performed ERCP and LC in both groups. Results No cases of morbidity or mortality occurred in any groups. The average length of stay was 8.03 ± 4.97 days in Group A, which was significantly longer (9.92 ± 4.05 days) in Group B (p <0.026). However, the length of stay (in days) was calculated as the time from presentation to hospital until discharge and not the time elapsed after the procedure. Imaging methods were used 3.9 ± 3.07 times in Group A and significantly more frequently (5.92 ± 2.55 times) in Group B (p <0.001). Total duration of anesthesia was not statistically significantly different between the study groups (154.06 ± 53.76 min in Group A and 167.04 ± 75.17 min in Group B). Conclusion In conclusion, single-stage ERCP/LC is associated with shorter hospital stay and lower frequency of imaging and can be safely used in selected cases. No cases of pancreatitis or mortality occurred following the single-stage procedure. The single-stage procedure can be safely used in selected patients with obstructive jaundice.
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Ghazanfor R, Liaqat N, Changeez M, Tariq M, Malik S, Ghazanfar KR, Khan JS. Choledocholithiasis: Treatment Options in a Tertiary Care Setup in Pakistan. Cureus 2017; 9:e1587. [PMID: 29062619 PMCID: PMC5650263 DOI: 10.7759/cureus.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Among patients with cholelithiasis, choledocholithiasis may also be present in about 18% of cases. They can be treated through various endoscopic, laparoscopic, and open surgical procedures. Objective The objective of this study was to determine the outcome of patients with choledocholithiasis being treated in our setup. Methods This descriptive case series was conducted at Holy Family Hospital, Rawalpindi, Pakistan over two years from January 2015 to December 2016. All patients with choledocholithiasis admitted to Surgical Unit 1 were included in this study. All patients underwent elective endoscopic retrograde cholangiopancreatography (ERCP). In patients with successful ERCP, laparoscopic or open cholecystectomy was performed at a later date. In patients in whom ERCP failed, open surgical clearance of the common bile duct (CBD), along with cholecystectomy, was done. Results A total of 200 cases of choledocholithiasis were admitted during the study period. Most of the participants (73%) in this study were female. Liver function tests were found to be deranged in 88 patients (44%) and normal in 112 patients (56%). At presentation, 3.5% (n=7) had concomitant acute biliary pancreatitis and 8% (n=16) had cholangitis. Successful ERCP followed by cholecystectomy was performed in 88.5% of cases. On the other hand, 11.5% (n=23) patients had failed ERCP due to impacted stones. They underwent open surgical procedures, i.e. 43.48% (n=10) had choledochotomies, 47.82% (n=11) had choledochoduodenostomies and 8.69% (n=2) had hepaticojejunostomies. No postoperative mortality was observed. However, anastomotic leaking occurred in 8.69% cases (n=2). Conclusion A two-staged procedure consisting of ERCP, followed by laparoscopic cholecystectomy, should be the first line of treatment for common bile duct (CBD) stones. In cases where ERCP fails, open surgical procedures still remain a relevant and a definitive option in resource-constrained setups.
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Affiliation(s)
| | - Naeem Liaqat
- Department of Surgery, Unit 1, Holy Family Hospital, Rawalpindi
| | | | - Maham Tariq
- Department of Surgery, Unit 1, Holy Family Hospital, Rawalpindi
| | - Sara Malik
- Department of Surgery, Unit 1, Holy Family Hospital, Rawalpindi
| | | | - Jahangir S Khan
- Department of Surgery, Unit 1, Holy Family Hospital, Rawalpindi
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