LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure

Navarro‐Sánchez, Antonio; Ashrafian, Hutan; Segura-Sampedro, Juan José; Martrinez-Isla, Alberto

doi:10.1007/s00464-016-5206-1

Cited by 34 publications

(19 citation statements)

References 28 publications

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“…The reflux of bile indicates the presence of a fistula between the gallbladder/infundibulum/dilated cystic duct and the bile duct, as the cystic duct is usually occluded [5]. IOC and choledochoscopy will also help to identify the anomalous fistula anatomy and perform a safer dissection within the hepatic hilum, aided by the LABEL technique in cases with large stones [5,19,20,22]. Since the introduction of the transinfundibular approach at our institution, we have noticed a decrease in the cases labelled as type II Mirizzi syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…More recently (from February 2014), the laser-assisted bile duct exploration by laparoendoscopy (LABEL) technique, through the transinfundibular route was used in selected cases for fragmentation of large or impacted stones permitting complete CBD exploration and stone clearance whilst avoiding choledochotomy and/or fistulotomy (Fig. 2) [20,21]. Closure of the CBD defect was mainly performed over a decompressed duct using a T-tube, antegrade stent or cholangiocatheter (10/11 patients).…”

Section: Surgical Technique: Transinfundibular Approachmentioning

confidence: 99%

“…1) [19,22]. The LABEL technique was used as an adjunct in the management of large and/or impacted stones along the fistulous tract, allowing full access and subsequent complete clearance of the bile duct [5,20,22].…”

Section: Surgical Technique: Transinfundibular Approachmentioning

confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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Background Mirizzi syndrome is an uncommon complication of longstanding gallstone disease. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently open cholecystectomy was the standard of care for type II Mirizzi syndrome (McSherry classification). The objective of this study was to assess the incidence and management of type II Mirizzi syndrome in patients with proven or suspected choledocholithiasis undergoing laparoscopic common bile duct (CBD) exploration and present our experience in the laparoscopic management of this rare condition over the last 21 years. Methods Prospective data collection of eleven cases of type II Mirizzi syndrome amongst a series of 425 laparoscopic bile duct explorations was performed between 1998 and 2019. Demographic, clinical, diagnostic, intra-operative, and postoperative data were recorded. Results The incidence of type II Mirizzi syndrome was 2.6% in 425 laparoscopic CBD explorations. All operations were completed laparoscopically with closure of the defect over a decompressed CBD (T-tube n = 3, antegrade stent n = 5, transcystic drain n = 2), and in one case a non-drained duct was closed with Endoloop. Stone clearance rate was 100% (11 cases). In two patients the transinfundibular approach was used in conjunction with holmium laser lithotripsy to enable choledochoscopy and successful stone clearance. Three patients were complicated in the post-operative period with bile leak (n = 2) and lower respiratory tract infection (n = 1). An incidental gallbladder carcinoma was found in one patient. Conclusion Laparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Technique: Transinfundibular Approachmentioning

confidence: 99%

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Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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“…These would probably increase the rate of transcystic instrumentations and decrease the conversion rate. 42…”

Section: Discussionmentioning

confidence: 99%

Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital

et al. 2019

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Available online xxx Keywords:Common bile duct stones Choledocholithiasis Single-stage treatment One-step treatment Transcystic approach Choledochotomy a b s t r a c t Background: Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment.Methods: A prospective cohort study of patients diagnosed with cholelithiasis and choledocholithiasis who were treated with the single-stage treatment e transcystic instrumentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) e between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate.Results: 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after "flushing" in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients (16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. Conclusions:Single-stage approach is a safe and effective management option for concomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a transcystic approach, with presumable low morbidity and cost-efficiency.

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“…Varban and colleagues were the first group to publish a case series on the use of holmium laser lithotripsy for CBD stones [13]. In 2017, our group published our initial experience of laser-assisted bile duct exploration by laparoendoscopy (LABEL) for the management of complex choledocholithiasis, thereby improving surgical outcomes and reducing technical failure [15]. Further to our report, other groups have also been able to demonstrate safety and efficacy of laser lithotripsy when used as an adjunct to TC LCBDE for large and/or impacted CBD stones [16,17].…”

Section: Introductionmentioning

confidence: 99%

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Jones

Musawi

Navaratne

et al. 2019

Langenbecks Arch Surg

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Purpose Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy. Methods Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction. Results One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III-IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively. Conclusions LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.

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LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure

Abstract: LABEL technique is a successful and safe method to enhance LBDE in cases of impacted or large stones. In our experience, this approach increases the feasibility of the transcystic stone retrieval and may reduce overall operative time.

Cited by 34 publications

References 28 publications

Laparoscopic management of type II Mirizzi syndrome

Laparoscopic management of type II Mirizzi syndrome

Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

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