Common bile duct calculi--ERCP vs laparoscopic exploration: the case for endoscopic retrograde cholangiopancreatography (ERCP) (original) (raw)
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Journal of laparoendoscopic & advanced surgical techniques. Part A, 2015
This study aimed to evaluate the efficacy and safety of laparoscopic management of common bile duct (CBD) stones in a single session in comparison with two-session procedures including endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC). The most popular approach to treat CBD stones that were detected before LC is with ERCP followed by LC. This two-session approach has some disadvantages, which include spontaneous passage of stones found on magnetic resonance cholangiopancreatography while awaiting ERCP, the risk for CBD stone passage between ERCP and LC or during LC due to excessive gallbladder handling, and the need for multiple anesthesia sessions and hospital admissions within a short interval. A prospective outcome analysis was done for 150 patients with CBD stones treated either laparoscopically in a single session with either transcystic exploration (conducted in 23 cases) or CBD exploration (conducted in 46 cases) (Group I included 75 ...
A 23 year experience with laparoscopic common bile duct exploration
HPB : the official journal of the International Hepato Pancreato Biliary Association, 2017
Laparoscopic common bile duct exploration (LCBDE) during laparoscopic cholecystectomy (LC) is as effective as two-stage endo-laparoscopic treatment, but with shorter hospital stay, lower cost and recurrent stone rate. Aim of this paper was to report the authors' experience with LCBDE during LC. A retrospective analysis of patients who underwent LCBDE for ductal stones was performed. Recurrent stones were defined as CBD stones detected beyond 6 months from the procedure. Postoperative biliary stricture was defined as a symptomatic reduction of CBD diameter. Out of 3444 patients who underwent LC, 384 (11%) had CBD stones treated by trans-cystic duct exploration [214 (6%) patients, TCD-CBDE] or choledochotomy [170 (5%) patients, C-CBDE]. For TCD-CBDE and C-CBDE, mean operative time was 127 ± 69 and 191 ± 74 min, respectively. Major morbidity rate was 3% (n = 6) in TCD-CBDE and 6% (n = 11) in C-CBDE. The incidence of residual stones was 5% (n = 20) and complete ductal clearance rate...
Laparoscopic Treatment of Gallbladder and Common Bile Duct Stones: A Prospective Study
World Journal of Surgery, 1996
The aim of this study was to investigate prospectively the feasibility, success rate, safety, and short-term results of single-stage laparoscopic treatment of gallstones and ductal stones in 100 consecutive, unselected patients. Common bile duct (CBD) stones were diagnosed at routine intraoperative cholangiography and choledochoscopy in 100 of 950 patients with gallstones undergoing laparoscopic cholecystectomy (LC). Unsuspected CBD stones were present in 39 patients (4.1% of 950; 39% of 100); 26 patients were referred for surgery after failed endoscopic sphinctertomy (ES) performed elsewhere. Transcystic duct CBD exploration (TC-CBDE) was the procedure of choice. When it was not feasible, choledochotomy and direct CBD exploration (D-CBDE) was performed.
Surgical Endoscopy, 2020
Background The management of choledocholithiasis evolves with diagnostic imaging and therapeutic technology, facilitating a laparoscopic approach. We review our first 200 cases of laparoscopic exploration of the common bile duct, highlighting challenges and lessons learnt. Methods We retrospectively studied the first 200 cases of laparoscopic cholecystectomy with common bile duct exploration between 2006 and 2019. The database contains demographics, clinicopathological characteristics, diagnostic modalities, operative techniques, duration and outcomes. Results We compared two approaches: transcystic vs. transcholedochal in our 200 cases. Choledocholithiasis was suspected preoperatively in 163 patients. 21 cases found no stones. Of the remainder, 111/179 cases were completed via the transcystic route and the remaining were completed transcholedochally (68/179); 25% of the transcholedochal cases were converted from a transcystic approach. CBD diameter for transcystic route was 8.2 vs. 11.0 mm for transcholedochal. Total clearance rate was 84%. Retained or recurrent stones were noted in 7 patients. Length of stay was 5.8 days, 3.5 days in the transcystic route vs. 9.4 days after transcholedochal clearance. Eight patients required re-operation for bleeding or bile leak. No mortalities were recorded in this cohort, but 2 cases (1%) developed a subsequent CBD stricture. Conclusion Concomitant laparoscopic common bile duct clearance with cholecystectomy is feasible, safe and effective in a district general hospital, despite constraints of time and resources. The transcystic route has a lower complication rate and shorter hospital stay, and hence our preference of this route for all cases. Advancements in stone management technology will allow wider adoption of this technique, benefitting more patients. Keywords Common bile duct exploration • Common bile duct clearance • Transcystic • Choledocholithiasis Choledocholithiasis is present in approximately 10-15% of patients with gallstones [1, 2]. This proportion may reach 15-60% in elderly patients [3], making it a common problem to manage by both surgeons and endoscopists. The management of choledocholithiasis remains a challenge, despite progress in instrumentation and technology and advancement in endoscopic and laparoscopic skills with no universal consensus on the best therapeutic approach. The significant resultant morbidity and mortality from the presence of stones in the common bile duct (CBD) led to development of the European Association of Endoscopic Surgery (EAES) Guidelines advising treatment of all CBD stones even if asymptomatic [3]. Management protocols for CBD stones with gallbladder in situ vary widely, depending on availability of equipment, expertise and resources. The main approaches are preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC); LC with intra-operative ERCP, LC and post-operative ERCP; and open CBD exploration and the evolving single-stage
World Journal of Surgery
The aim of this study was to investigate prospectively the feasibility, success rate, safety, and short-term results of single-stage laparoscopic treatment of gallstones and ductal stones in 100 consecutive, unselected patients. Common bile duct (CBD) stones were diagnosed at routine intraoperative cholangiography and choledochoscopy in 100 of 950 patients with gallstones undergoing laparoscopic cholecystectomy (LC). Unsuspected CBD stones were present in 39 patients (4.1% of 950; 39% of 100); 26 patients were referred for surgery after failed endoscopic sphinctertomy (ES) performed elsewhere. Transcystic duct CBD exploration (TC-CBDE) was the procedure of choice. When it was not feasible, choledochotomy and direct CBD exploration (D-CBDE) was performed.
Clinical evaluation of laparoscopic exploration of the common bile duct
Ain Shams Journal of Surgery, 2009
The management of CBD stones has traditionally required open laparotomy and bile duct exploration. Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), preoperative clearance of common bile duct (CBD) stones prior to cholecystectomy has been widely adopted. 1 However, in the present laparoscopic era, the best treatment for patients with choledocholithiasis is a matter of debate and the management of choledocholithiasis continues to evolve. If the stones are found by intraoperative cholangiography during laparoscopic cholecystectomy(LC), the surgeon may either do the LC and refer the patient to endoscopic sphincterotomy(ES) postoperatively,or he may convert to open CBD exploration or in the current times he may do laparoscopic CBD exploration (LCBDE). 2
Gastrointestinal Endoscopy, 1999
No procedure has yet been identified as the standard for the detection and management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy. A prospective study involved 1305 patients undergoing elective laparoscopic cholecystectomy. Intravenous cholangiography was performed on all patients except those with jaundice or cholangitis, acute pancreatitis, or allergy to contrast material. Patients underwent endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy when there was a strong suspicion of choledocholithiasis, positive or inconclusive findings on intravenous cholangiography or allergy to contrast material with signs of possible choledocholithiasis. Intraoperative cholangiography was performed when patients did not undergo ERC or intravenous cholangiography and whenever the surgeon was in doubt about biliary anatomy or biliary clearance. Two hundred thirty-one patients (17.7%) were referred for preoperative ERC; 14 of them were referred for open surgery because of failure of ERC or sphincterotomy. Only 54 patients underwent intraoperative cholangiography. Bile duct stones, detected in 186 cases (14.2%) (68 of which were asymptomatic), were removed before surgery in 162 cases (87.1%) and during surgery in 20 (10.7%). Self-limited pancreatitis occurred in 3.6% of the patients after sphincterotomy. Laparoscopic cholecystectomy was performed in 98.7% of the cases. The conversion rate was 8% if sphincterotomy had been performed previously, and 3% after standard laparoscopic cholecystectomy (p < 0.001). The morbidity rate was 5% and the mortality rate 0.08%. During the follow-up period 4 patients had retained stones that were treated endoscopically. Preoperative ERC followed by laparoscopy is the best approach to treatment of patients with cholecystolithiasis and suspected choledocholithiasis.
Laparoscopic common bile duct exploration: the past, the present, and the future.
BACKGROUND: The advent of laparoscopic cholecystectomy (LC) has created a dilemma for treating patients with known or suspected choledocholithiasis. With rapid technologic growth and experience in laparoscopic skills, many surgeons are now routinely performing laparoscopic common bile duct exploration (LCBDE) and questioning the wisdom of preoperative endoscopic retrograde cholangiography (ERC) with or without endoscopic sphincterotomy. The purpose of this article is to review the current literature on the subject of LCBDE and critically evaluate the clinical results of this emerging technology. METHODS: Medline and Science Citation Index databases were used to search English language articles published on LCBDE since 1989. RESULTS: Transcystic common bile duct exploration has a better clearance rate, and carries less morbidity and mortality compared with laparoscopic choledochotomy. Compared with two-stage ERCP and LC, one-stage LC and LCBDE seems to be associated with a shorter hospital stay, a quicker recovery, less expense, and less morbidity and mortality. CONCLUSIONS: LCBDE is a feasible, safe and effective procedure that carries a low morbidity and mortality and will decrease the need for unnecessary ERC in the future for suspected or proved choledocholithiasis.