Common bile duct stones management: A network meta-analysis

Mohseni, Shahin; Bass, Gary Alan; Forssten, Maximilian Peter; Casas, Isidro Martínez; Martin, Matthew J.; Davis, Kimberly A.; Haut, Elliott R.; Sugrue, Michael; Kurihara, Hayato; Sarani, Babak; Cao, Yang; Coimbra, Raúl

doi:10.1097/ta.0000000000003755

Cited by 9 publications

(11 citation statements)

References 42 publications

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“…36 Therefore, when laparoscopic CBDE expertise is not available, this method is a suitable substitution for single stage ductal clearance and demonstrated equivalence in recent network meta-analysis. 15…”

Section: Concomitant Cholecystectomy and Ercpmentioning

confidence: 99%

“…The management of choledocholithiasis has evolved over the past decade with a growing body of literature that supports single stage therapy (i.e., operative intervention with concomitant ductal clearance) for those with symptomatic disease. [15][16][17] This can be achieved through several intraoperative modalities that will be described in the following sections. Institutional expertise and availability will ultimately dictate which single stage care path is undertaken.…”

Section: Management Of Confirmed or Highly Suspected Cholodocholithiasismentioning

confidence: 99%

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Contemporary management of common bile duct stone: What you need to know

Hwang,

Bukur

2023

J Trauma Acute Care Surg

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Choledocholithiasis is a common presentation of symptomatic cholelithiasis encountered by the acute care surgeon. There is a wide spectrum of variation in management of this disease due to evolutions in laparoscopic and endoscopic techniques. Intricacies in management are related to the timing of diagnosis as well as locally available imaging modalities, surgical expertise, and ancillary advanced endoscopy and interventional radiological support. While individual patient demographics and institutional characteristics will determine management of choledocholithiasis, it is incumbent for the treating surgeon to be well versed in all manners of therapy currently available. The objective of this review is to provide an evidence-based summary of the contemporary management of choledocholithiasis.

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Section: Concomitant Cholecystectomy and Ercpmentioning

confidence: 99%

Section: Management Of Confirmed or Highly Suspected Cholodocholithiasismentioning

confidence: 99%

Contemporary management of common bile duct stone: What you need to know

Hwang,

Bukur

2023

J Trauma Acute Care Surg

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“…The requirement of specific equipment and advanced training are drawbacks for LCBDE[ 8 ]. LCBDE and intraoperative ERCP have similar good outcomes[ 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…The recurrence after successful CBD stone clearance reaches up to 8.4% within a median time of 2.5 years, and it is more often found after ERCP-ES than after LCBDE[ 18 , 22 ]. This is particularly related to some morphological subtypes (S and polyline type) of CBD[ 23 ], and regular follow-up is necessary in cases with risk factors[ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Current management of concomitant cholelithiasis and common bile duct stones

Pavlidis¹,

Pavlidis²

2023

World J Gastrointest Surg

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The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

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“…Elevated liver function tests have positive predictive value. In most patients, serum bilirubin, alkaline phosphatase, and gamma-glutamyltransferase are elevated, which has the highest sensitivity and specificity for the diagnosis of common bile duct stones [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis

et al. 2022

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Background: In recent years, complicated biliary tract diseases are increasingly diagnosed in children. Laparoscopic exploration of the common bile duct (LCBDE) followed by laparoscopic cholecystectomy has gained popularity in children. The aim of this study was to investigate the outcomes of LCBDE in children and compare them with the treatment outcomes of previously used endoscopic retrograde cholangiopancreatography (ERCP). Methods: From January 2000 to January 2022, a total of 84 children (78.5% female) underwent laparoscopic cholecystectomy with a median follow-up of 11.4 (IQR 8, 14) years. Of these, 6 children underwent laparoscopic cholecystectomy (LC) + ERCP and 14 children underwent LCBDE for choledochiothiasis. The primary end point of the study was the success of treatment in terms of the incidence of complications, recurrence rate, and rate of reoperation. Secondary endpoints were stone characteristics, presenting symptoms, duration of surgery, and length of hospital stay. Results: The majority of patients were female in both groups (83.5% vs. 85.7%), mostly overweight with a median BMI of 27.9 kg/m2 and 27.4 kg/m2, respectively. Obstructive jaundice, colicky pain, acute pancreatitis, and obstruction of the papilla were the most common symptoms in both groups. The majority of patients (68%) had one stone, whereas two or more stones were found in 32% of patients. The median diameter of the common bile duct was 9 mm in both groups. The procedure was successfully completed in all patients in the ERCP group. In the group of patients treated with LCBDE, endoscopic extraction of the stone with a Dormia basket was successfully performed in ten patients (71.4%), while in the remaining four patients (28.6%) the stones were fragmented with a laser because extraction with the Dormia basket was not possible. The median operative time was 79 min in the LCBDE group (IQR 68, 98), while it was slightly longer in the ERCP group, 85 min (IQR 74, 105) (p = 0.125). The length of hospital stay was significantly shorter in the LCBDE group (2 vs. 4 days, p = 0.011). No complications occurred in the LCBDE group, while two (40%) complications occurred in the ERCP group: pancreatitis and cholangitis (p = 0.078). During the follow-up period, no conversions, papillotomies, or recurrences were recorded in either group. Conclusions: Exploration of the common bile duct and removal of stones by LCBDE is safe and feasible in pediatric patients for the treatment of choledocholithiasis. Through this procedure, choledocholithiasis and cholelithiasis can be treated in a single procedure without papillotomy or fluoroscopy. Compared with LC + ERCP, LCBDE is associated with a shorter hospital stay. The incidence of complications was rather low but not statistically significant.

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Common bile duct stones management: A network meta-analysis

Cited by 9 publications

References 42 publications

Contemporary management of common bile duct stone: What you need to know

Contemporary management of common bile duct stone: What you need to know

Current management of concomitant cholelithiasis and common bile duct stones

The Laparoscopic Cholecystectomy and Common Bile Duct Exploration: A Single-Step Treatment of Pediatric Cholelithiasis and Choledocholithiasis

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