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Bogut A, Saric I, Dragisic V, Azinovic A, Romic I, Bakula B, Puljiz M, Puljiz Z. Extraction Basket Entangled in Surgical Sutures in Common Bile Duct Forty-Five Years After Hepatobiliary Surgery: A Bizarre Adverse Event of Endoscopic Retrograde Cholangiopancreatography. Gastroenterology Res 2024; 17:183-188. [PMID: 39247708 PMCID: PMC11379044 DOI: 10.14740/gr1752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/17/2024] [Indexed: 09/10/2024] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for treating biliary obstruction. A case report of a 75-year-old male with diagnosed choledocholithiasis and cholangitis was presented. He had a history of hepatic surgery 45 years ago, and during the ERCP, an unusual clinical scenario was encountered. Retained extraction basket during ERCP is a rare but known complication and there are no standard recommendations to manage it. To our knowledge, this is the first case report described in the literature with retention of an extraction basket in surgical sutures at ERCP and the longest period from surgery to stone formation in the biliary system. This case report aims to emphasize that in patients with a history of hepatobiliary surgery, postoperative material can cause complications during ERCP.
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Affiliation(s)
- Ante Bogut
- Department of Gastroenterology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Saric
- Department of Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Vedran Dragisic
- Department of Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Andela Azinovic
- Department of Surgery, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ivan Romic
- Department of Abdominal Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Branko Bakula
- Department of Surgery, University Hospital Sveti Duh Zagreb, Zagreb, Croatia
| | - Marko Puljiz
- Department of Surgery, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - Zeljko Puljiz
- Department of Gastroenterology, University Hospital Center Split, Split, Croatia
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Su Z, Zhang J, Lin C, Li H, Liu L, Chen H, Wang S, Xing S. Comparison of laparoscopic choledochotomy and endoscopic retrograde cholangiopancreatography in the treatment of senile bile duct calculi. Minerva Gastroenterol (Torino) 2024; 70:250-252. [PMID: 37232147 DOI: 10.23736/s2724-5985.23.03444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Zijian Su
- Department of Hepatobiliary Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Jianhua Zhang
- Department of Hepatobiliary Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Chuncheng Lin
- Department of Hepatobiliary Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Huiqiang Li
- Department of Hepatobiliary Surgery, Quanzhou First Hospital, Quanzhou, China
| | - Li Liu
- Department of Hepatobiliary Surgery, The Graduate School of Fujian Medical University, Fuzhou, China
| | - Haowei Chen
- Department of Hepatobiliary Surgery, The Graduate School of Fujian Medical University, Fuzhou, China
| | - Senquan Wang
- Department of Hepatobiliary Surgery, The Graduate School of Fujian Medical University, Fuzhou, China
| | - Shilong Xing
- Department of Hepatopancreatobiliary Surgery, Jiujiang N.1 People's Hospital, Jiujiang, China -
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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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Ji H, Hou Y, Cheng X, Zhu F, Wan C, Fang L, Fang L. Association of Laparoscopic Methods and Clinical Outcomes of Cholecystolithiasis Plus Choledocholithiasis: A Cohort Study. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:35-42. [PMID: 36445052 PMCID: PMC9985062 DOI: 10.5152/tjg.2022.22110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
> Background: Various surgical methods are available for cholecystolithiasis plus choledocholithiasis. The objective of this study is to explore the association between laparoscopic methods and clinical outcomes of cholecystolithiasis plus choledocholithiasis. METHODS This cohort study retrospectively included patients who underwent laparoscopic surgery for cholecystolithiasis plus choledocholithiasis at our hospital (January 2017 to March 2021). The primary outcome was bile leakage. RESULTS Totally 127 patients were enrolled. The time to get out of bed and the indwelling duration of the abdominal drainage tube in the patients who underwent laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage were higher than the endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy group, without differences in the laparoscopic common bile duct exploration group (all P < .05). All indexes decreased in the 3 groups after surgery (all P < .01). On the first day after surgery, only white blood cells (P < .001) and gamma-glutamyl transferase (P = .045) showed significant differences among the different surgical methods. The incidence of biliary leakage (P = .001) was higher in laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, while the occurrence of hyperamylasemia was higher with endoscopic retrograde cholangiopancreatography+laparoscopic cholecystectomy (P = .001). Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with fewer bile leakage (RR = 0.03, 95% CI: 0.003-0.37). CONCLUSION Compared with laparoscopic cholecystectomy+lithotomy of common bile duct+common bile duct primary suture+endoscopic nasobiliary drainage, laparoscopic common bile duct exploration was associated with bile leakage.
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Affiliation(s)
| | - Yafeng Hou
- Corresponding author: Yafeng Hou, e-mail:
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Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterol 2022; 22:509. [PMID: 36494797 PMCID: PMC9733260 DOI: 10.1186/s12876-022-02601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The best intervention approach for residual choledocholithiasis after choledocholithotomy T-tube drainage remains controversial, especially during the period of indwelling T tube and the formation of a sinus. The purpose of the study was to estimate the effects of two therapeutic modalities, namely endoscopic retrograde cholangiopancreatography (ERCP) and choledochfiberscope via the T-tube sinus tract (CDS) on residual choledocholithiasis after choledocholithotomy T-tube drainage. METHODS A total of 112 patients with residual choledocholithiasis after choledochotomy were included in the study, 50 of which underwent ERCP and 62 patients experienced choledochoscopy via the T-tube sinus tract. The primary outcome measures included the success rate of remove biliary stones, T-tube drainage time, and the average length of hospital stay. The secondary objective was to consider incidence of adverse events including cholangitis, bile leakage, T-tube migration, pancreatitis, bleeding and perforation. After hospital discharge, patients were followed up for two years and the recurrence of choledocholithiasis was recorded. RESULTS There was no significant difference in the success rate of stone removal between the two groups. Compared to CDS group, T-tube drainage time and the average length of hospital stay was significantly shorter in the ERCP group. The incidence of complications (cholangitis and bile leakage) in the ERCP group was lower than that in the CDS group, but there was no statistically significant difference. When the T-tube sinus tract is not maturation, ERCP was the more appropriate endoscopic intervention to remove residual choledocholithiasis, particularly complicated with cholangitis at this time period. CONCLUSIONS ERCP is a safe and effective endoscopic intervention to remove residual choledocholithiasis after choledocholithotomy T-tube Drainage without the condition of T-tube sinus tract restriction.
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Hwang S, Jung DH, Lee SK, Kim MH. Indication and surgical techniques of bypass choledochojejunostomy for intractable choledocholithiasis. Ann Hepatobiliary Pancreat Surg 2021; 25:259-264. [PMID: 34053929 PMCID: PMC8180391 DOI: 10.14701/ahbps.2021.25.2.259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
Despite development in endoscopic treatment and minimally invasive surgery for choledocholithiasis, there remains a small number of patients who require bypass Roux-en-Y choledochojejunostomy (RYCJ) because of the intractable occurrence of common bile duct (CBD) stones. We herein present the detailed procedures of open RYCJ customized for intractable choledocholithiasis. The first method is a side-to-end choledochojejunostomy with intraluminal closure of the distal CBD. This method was applied to a 79-year-old female patient who underwent endoscopic retrograde cholangiopancreatography (ERCP) more than 10 times in the past 14 years (Case No. 1). The distal CBD was explored through choledochotomy and then the distal CBD lumen was occluded with internal running sutures. A large-sized choledochojejunostomy was performed. The patient recovered uneventfully and has been doing well for the past 2 years. The second method is an end-to-end choledochojejunostomy with segmental CBD resection. It was applied to a 75-year-old male patient who underwent ERCP 9 times in the past 10 years (Case No. 2). The CBD was resected segmentally and a large-sized choledochojejunostomy was performed. The patient also recovered uneventfully and has been doing well for the past 2 years. In conclusion, the primary indication of bypass RYCJ is intractable choledocholithiasis which requires numerous sessions of endoscopic stone removal over a long period. Open RYCJ is the preferred procedure to date. If the papilla is patulous, the distal CBD should be occluded or resected to prevent reflux ascending cholangitis. We recommend to resect the intrapancreatic distal CBD if it is markedly dilated like choledochal cyst.
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Affiliation(s)
- Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wang Q, Zhang X, Sun L, Yang N. Primary Two-Layered Closure of the Common Bile Duct Reduces Postoperative Bile Leakage After Laparoscopic Common Bile Duct Exploration. J Laparoendosc Adv Surg Tech A 2020; 31:1274-1278. [PMID: 33347783 DOI: 10.1089/lap.2020.0768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The effectiveness and feasibility of the primary closure after laparoscopic common bile duct exploration (LCBDE) have been well demonstrated, however, the incidence of postoperative bile leakage after LCBDE remains high. The current study aimed at investigating whether our new suturing method could reduce the risk of bile leakage after LCBDE. Materials and Methods: This retrospective study included 81 patients who underwent primary two-layered closure or traditional primary closure of the common bile duct (CBD) after LCBDE, and the related clinical data were compared and analyzed. Results: The primary two-layered closure group had a lower rate of bile leakage compared with the traditional primary closure group (P < .05). There were no significant differences in additional parameters, such as operative time, estimated blood loss, postoperative stay duration, time to drain removal, postoperative pancreatitis, stone recurrence, and overall morbidity. No patients developed bile duct stenosis during the follow-up period. Conclusions: Primary two-layered closure of CBD can reduce the postoperative bile leakage after LCBDE. Moreover, it is a safe and effective therapeutic option for patients with choledocholithiasis.
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Affiliation(s)
- Qingda Wang
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, China
| | - Xiaozhou Zhang
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, China
| | - Louzong Sun
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, China
| | - Nan Yang
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, China
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Deng Y, Tian HW, He LJ, Zhang Y, Gu YH, Ma YT. Can T-tube drainage be replaced by primary suture technique in laparoscopic common bile duct exploration? A meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2020; 405:1209-1217. [PMID: 33005995 DOI: 10.1007/s00423-020-02000-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although laparoscopic common bile duct exploration (LCBDE) is considered the best treatment and has the advantages of being minimally invasive for common bile duct (CBD) stones, the choice of T-tube drainage (TTD) or primary duct closure (PDC) after LCBDE is still controversial. Therefore, the aim of the study was to compare the superiority of PDC versus TTD after LCBDE for choledocholithiasis. METHODS All potential studies which compare the surgical effects between PDC with TTD were electronically searched for in PubMed, Web of Science, and the Cochrane library databases up to November 2019. Data synthesis and statistical analysis were carried out using RevMan 5.3 software. RESULTS In total, six randomized controlled trials with 604 patients (307 in the PDC group and 297 in the TTD group) were included in the current meta-analysis. As compared with the TTD group, the pooled data showed that PDC group had shorter operating time (WMD = -24.30; 95% CI = -27.02 to -21.59; p < 0.00001; I2 = 0%; p < 0.88), less medical expenditure (WMD = -2255.73; 95% CI = -3330.59 to -1180.86; p < 0.0001; I2 = 96%; p < 0.00001), shorter postoperative hospital stay (OR = -2.88; 95% CI = -3.22 to -2.54; p < 0.00001; I2 = 60%; p < 0.03), and lower postoperative complications (OR = 0.49; 95% CI = 0.31 to 0.78; p = 0.77; I2 = 0%; p = 0.003). There were no significant differences between the two groups concerning bile leakage (OR = 0.74; 95% CI = 0.36 to 1.53; p = 0.42; I2 = 0%; p = 0.90) and retained stones (OR = 0.96; 95% CI = 0.36 to 2.52; p < 0.93; I2 = 0%; p < 0.66). CONCLUSIONS LCBDE with PDC should be performed as a priority alternative compared with TTD for choledocholithiasis.
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Affiliation(s)
- Yuan Deng
- Gansu Provincial Hospital, Lanzhou, China
| | | | - Lan-Juan He
- Gansu University of Chinese Medicine, Lanzhou, China.,Research Center Traditional Chinese Medicine, Gansu Province, Lanzhou, China
| | - Yan Zhang
- Gansu Provincial Hospital, Lanzhou, China
| | | | - Yun-Tao Ma
- Gansu Provincial Hospital, Lanzhou, China.
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Park SY, Hong TH, Lee SK, Park IY, Kim TH, Kim SG. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:578-582. [DOI: 10.1002/jhbp.675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sun Young Park
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
| | - Tae Ho Hong
- Department of Hepatobiliary and Pancreas Surgery Seoul St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Seoul Korea
| | - Sang Kuon Lee
- Department of General Surgery Daejeon St. Mary’s Hospital College of Medicine The Catholic University of Korea Daejeon Korea
| | - Il Young Park
- Department of General Surgery Bucheon St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Bucheon Korea
| | - Tae Hyeon Kim
- Division of Gastroenterology Department of Internal Medicine Wonkwang University Medical School and Hospital Iksan Korea
| | - Sung Geun Kim
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
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