Endoscopic removal of retained stones after biliary surgery

Lambert, Mark E.; Martin, D. F.; Tweedle, D. E. F.

doi:10.1002/bjs.1800750922

Cited by 25 publications

(6 citation statements)

References 30 publications

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“…ERCP for choledocholithiasis is still a widely used first-line technique but is associated with a high complication rate (19%) and mortality (3%) [14]. Patients awaiting interval cholecystectomy for gallstones risk repeated admissions and complications due to acute cholecystitis, pancreatitis, empyema, and cholangitis.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

et al. 2010

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“…A similar report indicated that complications occurred more than 22.2% in all stages 22 . It was also reported complication rate of 19% and mortality of 3% in endoscopic removal of retained stones after biliary surgery 23 . The simultaneous descent in postoperative cholangitis and hemobilia by CL strategy also proved its high efficiency in calculi lithotripsy when compared with EHL 24 .…”

Section: Discussionmentioning

confidence: 95%

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

Wen¹,

Ren²,

Wang³

et al. 2020

Sci Rep

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Although postoperative cholangioscopy (POC) guided electrohydraulic lithotripsy (EHL) is considered to be a conventional technique for residual biliary calculi, its efficacy still needs to be improved to fit in the managemet of refractory calculi. This study evaluated the efficacy and safety of combined lithotripsy of mechanical clamping and electrohydraulics in fragmentation and removal of refractory calculi. Totally, 281 patients, who suffered from residual biliary calculi after hepatectomy and underwnet POC from August 2016 to June 2018 were involved. The first 128 patients were subjected to conventional EHL, and later consective 153 to combined lithotripsyof mechanical clamping and EHL. Perioperative data, technical information, treatment outcomes and follow-up results were collected. Clinical characteristics were statistically comparable (P > 0.05). The overall POC interventional sessions (2.0 ± 0.65 vs. 2.9 ± 1.21 sessions), average operating time (99.1 ± 34.88 vs. 128.6 ± 72.87 minutes), incidence of intraoperative hemobilia (4.58% vs. 10.93%), cholangitis (6.54% vs. 14.06%), postoperative complications (10.45% vs. 21.87%), T-tube retaining time after first POC (20.7 ± 5.35 vs. 28.1 ± 8.28 days), and treatment costs ($2375 ± 661.72 vs. $3456.7 ± 638.07) were significantly lower in the combined lithotripsy group than those in the EHL group (P < 0.05). There were no differences between the two groups in calculi recurrence at half-a year, or one year follow-up. In conclusion, combined lithotripsy of mechanical clamping and electrohydraulics can safely and effectively benefit postoperative patients along with refractory residual biliary calculi. Although biliary calculus is a benign disease characterized for the presence of intrahepatic bile duct calculi, it may cause serious complications 1,2. Hepatectomy combined with intraoperative cholangioscopy is regarded as the most helpful approach not only for the removal of the intrahepatic calculi and lesions, but also for reducing the risk of calculi recurrence and cholangitis 3. Unfortunately, this technique is not suitable for complicated calculi distributing bilobarly or diffusely 4. In management of complicated calculi, placement of a T-tube drainage for further postoperative cholangioscopy (POC) was feasible, which allows for repeated sessions for calculi extraction 5,6. When dealing with complicated residual biliary calculi such as with large size, hard consistency, or anatomical abnormalities, conventional POC managements including perfusion and basket extraction are often difficult, or even impossible in patients with impacted calculi 7. Among advanced therapeutic strategies including electrohydraulic lithotripsy (EHL), laser lithotripsy, pneumatic lithotripsy and hyperacoustic lithotripsy, the EHL being the most commonly used in clinic because of its efficiency and low costs 8-11. It allows calculi to be crushed by energy absorption, which leads to a build-up of pressure gradients and the formation of shear and tear forces 9 .

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“…These developments render the operation of cho lecystectomy more attractive compared to other proce dures proposed [13][14][15]. The benefit of these new tech niques lies in reducing the necessity of operative cholan giography.…”

Section: Resultsmentioning

confidence: 99%

“…In the following period, all such cases were treated successfully and without mortality using either percuta neous or endoscopic techniques. Other reports have also concluded that both techniques are equally effective and safe, and the choice between them depends on the skills and experience of the available team [13,15,16], Major laparotomies for residual stones have become an anachronistic technique and should be limited to instances in which the alternative techniques were either not available or not successful.…”

Section: Resultsmentioning

confidence: 99%

Residual Stones in the Common Bile Duct: Critical Analysis following 2,700 Consecutive Cholecystectomies

et al. 1992

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A follow-up of 2,700 cholecystectomies disclosed 33 cases of residual stones (1.2%). A significant decrease in the rate of residual stones occurred in the last 2 years of the study (0.4%). Most residual stones occurred in patients with multiple choledochal stones found during the primary procedure. Since 1980 all residual stones were treated by percutaneous or endoscopic techniques, without mortality. Diminishing risks of treatment for residual stones following cholecystectomy significantly increase the costbenefit ratio of this procedure.

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Endoscopic removal of retained stones after biliary surgery

Cited by 25 publications

References 30 publications

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

Combined lithotripsy of mechanical clamping and electrohydraulics in facilitating endoscopic management of refractory residual biliary calculi after surgery

Residual Stones in the Common Bile Duct: Critical Analysis following 2,700 Consecutive Cholecystectomies

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