1
|
Ramser B, Coleoglou Centeno A, Ferre A, Thomas S, Brooke M, Pieracci F, Morton A. Laparoscopic common bile duct exploration is an effective, safe, and less-costly method of treating choledocholithiasis. Surg Endosc 2024:10.1007/s00464-024-11139-5. [PMID: 39138682 DOI: 10.1007/s00464-024-11139-5] [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: 04/19/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Advancements in laparoscopic techniques led to the adoption of laparoscopic common bile duct exploration (LCBDE) as an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for management of choledocholithiasis (CD). The goal of this study was to describe the initial experience at a safety net hospital with acute care surgeons performing LCBDE for suspected CD. We hypothesized LCBDE would reduce length of stay and hospital costs compared to laparoscopic cholecystectomy (LC) and ERCP performed in the same hospital admission. METHODS This was a retrospective case-control study from 2019 to 2023 comparing LCBDE to LC/ERCP among patients diagnosed with CD. Statistical analyses were performed using Mann-Whitney U tests for continuous variables and Chi-square tests for categorical variables. Data reported as median [interquartile range] or research subjects with condition (percentage). RESULTS A total of 110 LCBDE were performed, while 121 subjects underwent LC and ERCP. Patients in the LCBDE group were more likely to be female with a total of 87 female subjects (77.6%) compared to 76 male subjects (62.8%) (95% CI 1.14-3.74). Initial WBC was lower in the LCBDE group at 8.4 [6.9-11.8] compared to the LC/ERCP group at 10.9 [7.9-13.5] (p = 0.0013). Remaining demographics and lab values were similar between the two groups. Patients who underwent LCBDE had a significantly shorter length of stay at 2 days [1-3] compared to those in the LC/ERCP group at 4 days [3-6] (p < 0.001). Hospital charges for the LCBDE group were $46,685 [$38,687-$56,703] compared to $60,537 [$47,527-$71,739] for the LC/ERCP group (p < 0.001). CONCLUSION LCBDE is associated with significantly lower hospital costs and shorter length of stay with similar post-operative complication and 30-day readmission rates. Our results show that LCBDE is safe and should be considered as a first-line approach in the management of CD.
Collapse
Affiliation(s)
- Benjamin Ramser
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA.
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Adrian Coleoglou Centeno
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra Ferre
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sany Thomas
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Magdalene Brooke
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fredric Pieracci
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander Morton
- Department of Surgery, Denver Health Medical Center, Denver, CO, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
2
|
Sirimanna P, Suh H, Falk GL. Laparoscopic common bile duct exploration: what factors determine success? ANZ J Surg 2024; 94:375-379. [PMID: 37888880 DOI: 10.1111/ans.18756] [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: 07/04/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUNDS Laparoscopic common bile duct exploration (LCBDE) has been shown to be effective in managing choledocholithiasis whilst avoiding ERCP-related complications. However, patient and technical factors effects outcome. This study aimed to explore the matters effecting the failure of LCBDE. METHODS All patients who underwent a laparoscopic cholecystectomy (LC) between 2007 and 2021 were identified using a prospective database. Data were collected for patients who underwent LCBDE including demographics, pre-operative investigations, intra-operative findings, technique of bile duct clearance and clearance rates, and post-operative outcomes. Predictors of failed LCBDE were identified. RESULTS Laparoscopic cholecystectomy was performed in 3648 patients. Of these, 374 underwent LCBDE for suspected choledocholithiasis. Choledochoscopy was most frequently used (58.8%) with a success rate of 84.1%. Small cystic duct diameter (4.7 vs. 3.4 mm, P = 0.002), stone size >6 mm (P = 0.02), stone: cystic duct ratio >1 (P = 0.04), and >3 stones was associated with failed LCBDE by univariate analysis. Small cystic duct diameter (OR: 0.45, 95% CI: 0.26-0.77, P = 0.004) and stone size >6 mm (OR: 0.23, 95% CI: 0.06-0.92), P = 0.04) correlated with failure by multivariate analysis. Failed LCBDE was associated with increased length of stay (6.6 days vs. 3.1 days, P = 0.001), however the rate of serious complications or mortality was unaffected. CONCLUSION LCBDE is safe and effective in managing choledocholithiasis. Factors such as cystic duct diameter, size and number of CBD stones, and stone: cystic duct ratio are associated with increased likelihood of inadequate clearance. The presence of these factors can help clinicians in decision making during LCBDE to improve chance of success.
Collapse
Affiliation(s)
- Pramudith Sirimanna
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hyerim Suh
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Gregory L Falk
- Department of Upper GI Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| |
Collapse
|
3
|
Chan KS, Teo ZHT, Oo AM, Junnarkar SP, Shelat VG. Learning Curve of Laparoscopic Common Bile Duct Exploration: A Systematic Review. J Laparoendosc Adv Surg Tech A 2023; 33:241-252. [PMID: 36161969 DOI: 10.1089/lap.2022.0382] [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: 02/05/2023] Open
Abstract
Background: Single-stage laparoscopic common bile duct exploration (LCBDE) with cholecystectomy has superior outcomes over two-stage endoscopic retrograde cholangiopancreatogram with interval cholecystectomy. With decreasing trend of LCBDE, this study aims to summarize the literature on learning curve (LC) in LCBDE. Materials and Methods: PubMed, Embase, Scopus, and the Cochrane Library were systematically searched for articles from inception to June 3, 2022 (PROSPERO Ref No: CRD42022328451). Basic clinical demographics were collected. Poisson means (95% confidence interval [95% CI]) was used to determine the number of cases required to surmount the LC (NLC). Results: Eight articles (n = 2071 patients) reported LC outcomes in LCBDE with mean study period of 5.9 ± 2.8 years. Majority of studies (62.5%) used arbitrary methods of LC analysis. Most common outcomes reported were complications (any or major) (75%), open conversion (75%), length of stay (62.5%), and operating time (50%). Mean CBD diameter was 11.3 ± 4.8 mm (n = 1122 patients). Incidence of acute cholecystitis, acute cholangitis, and acute pancreatitis were 13.9% (n = 232/1668), 7.8% (n = 128/1629), and 13.7% (n = 229/1668), respectively. Pooled analysis of all the included studies showed NLC of 78.8 cases (95% CI: 71.9-86.3). Studies that used cumulative sum control chart analysis, nonarbitrary methods, and arbitrary-based LC had NLC of 152.0 (95% CI: 135.4-170.1), 108.0 (95% CI: 96.6-120.4), and 49.7 (95% CI: 42.0-58.3) cases, respectively. NLC was 37.0 cases (95% CI: 29.1-46.5) for single surgeon LC, and 99.8 cases (95% CI: 90.2-110.0) for institutional LC. Conclusion: Studies reporting NLC in LCBDE are heterogeneous. Further studies should use nonarbitrary methods of analysis for patient-reported outcome measures and procedure-specific morbidity.
Collapse
Affiliation(s)
- Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Aung Myint Oo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sameer P Junnarkar
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
4
|
Ng J, Teng R, Izwan S, Chan E, Kumar M, Damodaran Prabha R, Puhalla H. Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5-year tertiary centre experience. ANZ J Surg 2023; 93:139-144. [PMID: 36562109 DOI: 10.1111/ans.18215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of choledocholithiasis on routine intraoperative cholangiogram (IOC) during cholecystectomy is approximately 12%. Cholecystectomy without IOC may lead to undiagnosed choledocholithiasis placing patients at risk of complications such as pancreatitis or cholangitis. This study aims to determine the incidence of choledocholithiasis intraoperatively as well as the associated risk factors and the methods of management. METHODS A retrospective observational analysis of all laparoscopic cholecystectomies with IOC at the Gold Coast Hospital and Health Service from 1 January 2016 to 2 December 2021 was carried out. Patient demographics, operative data and cholangiogram findings were collected from electronic medical systems. RESULTS A total of 3904 cholecystectomies were carried out over the study period. 3520 (90.1%) had an IOC, and 474 (13.4%) had positive IOC findings. 158 (33.3%) of the cases were managed intraoperatively with hyoscine butylbromide with or without intravenous glucagon followed by biliary tree flushing alone, 183 (38.6%) received transcystic bile duct exploration (TCBDE) with a success rate of 83% and 167 (35.2%) received endoscopic retrograde cholangiopancreatography (ERCP). Choledocholithiasis was incidental in 44 (9.28%) patients. CONCLUSION Incidental choledocholithiasis during routine IOC is not uncommon. Management predominantly includes intraoperative TCBDE or postoperatively via an ERCP. This study has not found reliable preoperative factors to predict choledocholithiasis based on preoperative clinical, radiological and biochemical factors. A small proportion of patients received preoperative endoscopic intervention, and the decision-making process requires further investigation.
Collapse
Affiliation(s)
- Justin Ng
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Roy Teng
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Sara Izwan
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Erick Chan
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Maarisha Kumar
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Ramesh Damodaran Prabha
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Harald Puhalla
- Department of General Surgery, Gold Coast University Hospital-Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
5
|
Kao CT, Seagar R, Heathcock D, Tacey M, Lai JM, Yong T, Houli N, Bird D, Hodgson R. Factors That Predict the Success of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A 10-Year Study. Surg Laparosc Endosc Percutan Tech 2021; 31:565-570. [PMID: 33883540 DOI: 10.1097/sle.0000000000000938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) can be performed to treat choledocholithiasis at the time of laparoscopic cholecystectomy. The aim of this study was to identify factors that predict the success of LCBDE. MATERIALS AND METHODS A retrospective audit was performed on patients who underwent LCBDE for the management of choledocholithiasis at Northern Health between 2008 and 2018. RESULTS A total of 513 patients were identified with an overall success rate of 90.8%. Most LCBDE were done through a transcystic approach with the remainder through a choledochotomy. When comparing patients with a successful operation to those that were unsuccessful, univariate analysis demonstrated significant differences in preoperative white cell count and number of duct stones found. Age and elevated nonbilirubin liver function tests were found to be significant factors associated with the failure of LCBDE on multivariate analysis. The likelihood of a failed operation in those with multiple stones was observed to be almost halved compared with patients with single stone although this did not reach significance [odds ratio (OR): 0.53, 95% confidence interval (CI): 0.28-1.01, P=0.055]. Multivariate analysis indicated that unsuccessful procedures (OR: 10.13, 95% CI: 4.34-23.65, P<0.001) and multiple duct stones (OR: 3.79, 95% CI: 1.66-8.67, P=0.002) were associated with an increased risk of severe complications. CONCLUSIONS A single impacted stone may be more difficult to remove, however complications were more likely to be associated with multiple duct stones. With no other clinically relevant predictive factors, and because of the high success of the procedure and the low morbidity, LCBDE remains an option for all patients with choledocholithiasis.
Collapse
Affiliation(s)
| | | | | | - Mark Tacey
- Office of Research, Northern Health
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Vic., Australia
| | | | | | - Nezor Houli
- Division of Surgery
- Department of Surgery, Western Health, Footscray
| | | | - Russell Hodgson
- Division of Surgery
- Department of Surgery, University of Melbourne, Epping
| |
Collapse
|
6
|
Navaratne L, Martínez Cecilia D, Martínez Isla A. The ABCdE score for PREdicting Lithotripsy Assistance during transcystic Bile duct Exploration by Laparoendoscopy (PRE-LABEL). Surg Endosc 2020; 35:5971-5979. [PMID: 33057856 DOI: 10.1007/s00464-020-08082-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Common bile duct (CBD) stones are reported in ~ 15% of patients who undergo laparoscopic cholecystectomy for symptomatic gallstones. Prior to lithotripsy techniques, transcystic laparoscopic common bile duct exploration (LCBDE) was limited to smaller CBD stones. The addition of lithotripsy to LCBDE increases cost, operative time and staffing requirements. Predicting which patients might require lithotripsy would be useful in operative planning. The primary aim was to investigate clinical variables for predicting lithotripsy assistance during transcystic bile duct exploration by laparoendoscopy (PRE-LABEL). Secondary aims were to develop and validate a predictive scoring tool. METHODS A retrospective review of a prospectively collected database of consecutive patients who underwent transcystic LCBDE at a single centre in the UK was performed to investigate clinical variables for PRE-LABEL and develop a scoring tool (ABCdE score: age, bilirubin, CBD diameter, ERCP). Binary logistic regression was used to investigate which independent variables (predictors) were associated with lithotripsy assistance during transcystic LCBDE. The ABCdE score was applied to both UK and Spain patient cohorts to determine its sensitivity, specificity and accuracy. RESULTS From 8 pre-operative clinical variables analysed, age ≤ 40 years, bilirubin > two-times upper limit of normal, CBD diameter ≥ 10 mm and ERCP failure of stone extraction were independent predictors of requiring lithotripsy during transcystic LCBDE and formed the ABCdE score. The hazard ratios were 2.87, 3.79, 2.78 and 10.06, respectively. An ABCdE score ≥ 2 resulted in 71% sensitivity, 81% specificity and 79% accuracy in predicting lithotripsy during LCBDE (UK cohort). Validation using a contemporary cohort from Spain yielded similar sensitivity, specificity and accuracy. CONCLUSIONS This study represents the only study to date reporting independent predictors of requiring lithotripsy assistance during transcystic LCBDE. ABCdE score ≥ 2 can highlight patients that may require lithotripsy in order to avoid failure of transcystic LCBDE and therefore avoid choledochotomy or post-operative ERCP.
Collapse
Affiliation(s)
- Lalin Navaratne
- Department of Upper GI Surgery, Northwick Park Hospital & St Marks Hospitals, London, HA1 3UJ, UK.
| | | | - Alberto Martínez Isla
- Department of Upper GI Surgery, Northwick Park Hospital & St Marks Hospitals, London, HA1 3UJ, UK
| |
Collapse
|
7
|
Canullán C, Baglietto N, Merchán Del Hierro P, Petracchi E. Ten strategies to improve the efficacy of laparoscopic biliary surgery. Cir Esp 2020; 98:547-553. [PMID: 32684318 DOI: 10.1016/j.ciresp.2020.05.027] [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: 02/06/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers.
Collapse
Affiliation(s)
- Carlos Canullán
- Servicio de Cirugía General, Hospital Cosme Argerich, Buenos Aires, Argentina
| | - Nicolás Baglietto
- Servicio de Cirugía General, Hospital Cosme Argerich, Buenos Aires, Argentina
| | | | - Enrique Petracchi
- Servicio de Cirugía General, Hospital Cosme Argerich, Buenos Aires, Argentina.
| |
Collapse
|
8
|
Hajibandeh S, Hajibandeh S, Sarma DR, Balakrishnan S, Eltair M, Mankotia R, Budhoo M, Kumar Y. Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta-analysis. World J Surg 2019; 43:1935-1948. [PMID: 30993390 DOI: 10.1007/s00268-019-05005-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate comparative outcomes of laparoscopic transcystic (TC) and transductal (TD) common bile duct (CBD) exploration. METHODS We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. CBD clearance rate, perioperative complications, and biliary complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, conversion to open procedure were the secondary outcomes. Combined overall effect sizes were calculated using random-effects models. RESULTS We identified 30 studies reporting a total of 4073 patients comparing outcomes of laparoscopic TC (n = 2176) and TD (N = 1897) CBD exploration. The TC approach was associated with significantly lower overall complications (RD: -0.07, P = 0.001), biliary complications (RD: -0.05, P = 0.0003), and blood loss (MD: -16.20, P = 0.02) compared to TD approach. Moreover, the TC approach significantly reduced the length of hospital stay (MD: -2.62, P < 0.00001) and procedure time (MD: -12.73, P = 0.005). However, there was no significant difference in rate of CBD clearance (RD: 0.00, P = 0.77) and conversion to open procedure (RD: 0.00, P = 0.86) between two groups. CONCLUSIONS Laparoscopic TC CBD exploration is safe and reduces overall morbidity and biliary complications compared to the TD approach. Moreover, it is associated with significantly shorter length of hospital stay and procedure time. High-quality randomised trials may provide stronger evidence with respect to impact of the cystic duct/CBD diameter, number or size of CBD stones, or cystic duct anatomy on the comparative outcomes of TC and TD approaches.
Collapse
Affiliation(s)
- Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
| | - Shahab Hajibandeh
- Department of General Surgery, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Manchester, UK
| | - Diwakar Ryali Sarma
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sankar Balakrishnan
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mokhtar Eltair
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rajnish Mankotia
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Misra Budhoo
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Yogesh Kumar
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| |
Collapse
|
9
|
Ding GQ, Zhu JG, Wang D, Guo W, Zhang ZT. Five-year follow-up outcomes of laparoscopic choledochoscopy via the cystic duct for choledocholithiasis in patients with gallstones and common bile duct stones. Shijie Huaren Xiaohua Zazhi 2019; 27:756-760. [DOI: 10.11569/wcjd.v27.i12.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are many treatments for gallstones combined with common bile duct stones. Currently, laparoscopic cholecystectomy plus common bile duct exploration and endoscopic sphincterotomy plus laparoscopic cholecystectomy are often used, but T tube drainage is required for the former, and the latter is controversial due to the destruction of the Oddi sphincter.
AIM To investigate the clinical effect of laparoscopic choledochoscopy in the treatment of gallstones with common bile duct stones.
METHODS A total of 125 patients who underwent laparoscopic choledochoscopy and cholecystectomy for gallbladder stones and common bile duct stones were followed for 5 years from January to December 2013. The clinical effects were analyzed.
RESULTS The operation was successful in 122 cases, with a success rate of 97.6%. The average age of the patients was 58.21 ± 13.01 years old. The mean operation time was 87.95 ± 39.12 min, and mean intraoperative blood loss was 11.27 ± 6.85 mL. All patients underwent balloon dilatation, of whom 33 underwent microctomy at the confluence of the cystic duct and 5 underwent lithotrity via choledochoscopy. The mean time to first postoperative exhaust was 32.48 ± 17.85 h, and mean postoperative hospital stay was 2.03 ± 1.62 d. The rate of complications at short-term follow-up was 5.74%, and there were a total of 7 cases, including 4 cases of postoperative pancreatitis cured by symptomatic treatment with octreotide and ulinastatin, 2 cases of bile leakage cured by ENBD drainage, and 1 case of surgical wound infection cured by re-dresses. The rate of complications at 5-year follow-up was 4.92%, and there were 4 cases of recurrent common bile duct stones, including 1 case with intrahepatic bile duct stones and 2 cases with pancreatitis. Four patients died, of whom two patients had a myocardial infarction, one had a lung infection, and one had a car accident, all of which were not related to the operation.
CONCLUSION Laparoscopic choledochoscopy for the treatment of gallbladder stones combined with common bile duct stones has both good short- and long-term results, with the advantages of little trauma, rapid recovery, and few complications.
Collapse
Affiliation(s)
- Guo-Qian Ding
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Wei Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,National Center for Digestive Disease Research, Beijing 100050, China
| |
Collapse
|