3D laparoscopic common bile duct exploration is safe and feasible

Tan, Yen Pin; Huey, Cheong Wei Terence; Junnakar, S.P.; Low, Jee Keem; Shelat, Vishal G

doi:10.1016/j.hpb.2020.04.276

Cited by 3 publications

(2 citation statements)

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“…Although the current study had a high workload of biliary emergencies and subsequently a high percentage of difficult cholecystectomies, the morbidity rates for the whole study [6] were lower than many published studies [10][11][12][13][14][15][16]. Laparoscopic CBDEs were also performed in the emergency cohort with a low reintervention rate compared to other studies on CBDE [11][12][13][14][15][16][17][18] as shown in Table 5.…”

Section: Discussionmentioning

confidence: 66%

Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

Nassar

2021

Surg Endosc

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Background Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients’ quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE. Methods A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Preoperative factors, difficulty grading and perioperative complications requiring reintervention and readmissions were examined. Results Reinterventions were required in 112 of 5740 patients (2.0%), 89 (1.6%) being subsequent to complications. The reintervention cohort had a median age of 64 years, were more likely to be females (p < 0.0023) and to be emergency admissions (67.9%, p < 0.00001) with obstructive jaundice (35.7%, p < 0.00001). 46.4% of the reintervention cohort had a LC operative difficulty grade IV or V and 65.2% underwent a CBDE. Open conversion was predictive of the potential for reintervention (p < 0.00001). The most common single cause of reintervention was retained stones (0.5%) requiring ERCP followed by bile leakage (0.3%) requiring percutaneous drainage, ERCP and relaparoscopy. Relaparoscopy was necessary in 17 patients and open surgery in 13, 6 of whom not resulting from complications. There were 5 deaths. Conclusion This large series had a low incidence of reinterventions resulting from complications in spite of a high workload of index admission surgery for biliary emergencies and bile duct stones. Surgical or endoscopic reinterventions following LC alone occurred in only 0.8%. The most common form of reintervention was ERCP for retained CBD stones. This important outcome parameter of laparoscopic biliary surgery can be optimised through early diagnosis and timely reintervention for complications.

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Section: Discussionmentioning

confidence: 66%

Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

Nassar

2021

Surg Endosc

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“…These complications were treated conservatively. Tan KK [11] et al reported 8% complications in laparascopic CBD exploration of which the main were retained CBD stones and biliary leakage. Lygidaki's (1981) found incidence of postoperative complication in 2.8 to 5.1% of cases which included biliary leak, biliary peritonitis and wound infection.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of endoscopic and surgical management of CBD stones in terms of outcome, morbidity and mortality

Mj¹

2019

Int. J. Surg. Sci.

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Laparoscopic Cholecystectomy has superseded open cholecystectomy as the preferred method. One limitation of laparoscopic cholecystectomy as preferred to open cholecystectomy is in dealing with common bile duct stones. Laparoscopic CBD exploration is time consuming, needs harder ware, is an intensive procedure, has steep learning curve and risks injury to Common bile duct. The data was collected in a proforma approved by the guide. The diagnosis was made with relevant clinical history, physical examination, relevant investigations-Liver function tests, ultrasound-abdomen, endoscopic retrograde cholangiogram, CT-scan abdomen. All patients were worked up for the therapeutic procedures with all routine lab investigations, ECG, chest Xray and fitness for the procedure was taken from the physicians where ever necessary. In this study of 60 patients, 34 patients had no complications. 3 patients had wound infection. In 4 patients along with wound infection cholangitis and sepsis (1 each), pancreatitis in one patient and bile leak in one patient was observed. Each of the 5patients had pancreatitis and sepsis. Cholangitis was observed in 3 patients and 2 patients had bile leak through t-tube tract following its removal which persisted for 6 and 7 days respectively. Cholangitis along with pancreatitis, sepsis, bile leak was observed in 1, 1, 2 patients respectively.

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Pathophysiological consequences and treatment strategy of obstructive jaundice

Liu¹,

Sun²,

Xu³

et al. 2023

World J Gastrointest Surg

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Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.

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3D laparoscopic common bile duct exploration is safe and feasible

Cited by 3 publications

References 0 publications

Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients

The efficacy of endoscopic and surgical management of CBD stones in terms of outcome, morbidity and mortality

Pathophysiological consequences and treatment strategy of obstructive jaundice

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