Laparoscopic Bile Duct Exploration: Results of 160 Consecutive Cases With 2‐year Follow Up

Taylor, Craig; Kong, Justin; Ghusn, Michael; White, Stephen; Crampton, Nick; Layani, Laurent

doi:10.1111/j.1445-2197.2007.04091.x

Cited by 24 publications

(20 citation statements)

References 31 publications

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“…The same results were reported in 2007 study by Tailor et al [49] who did not find any benefit or reduction in rates of biliary leak with use of biliary stents after LCBDE. Other authors recommend selective stent use only when purulent material, sludge, or numerous stones have been extracted from the biliary system.…”

Section: Discussionsupporting

confidence: 78%

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

et al. 2015

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Section: Discussionsupporting

confidence: 78%

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

et al. 2015

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“…Many authors agree that IOC can be safely avoided in patients with no clinical, biochemical or radiological indications of CBD stones. 6,9 . In our series, 98% of intra-operative cholangiograms attempted were completed successfully, comparing favourably with previously published data.…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones

Horwood

Akbar

Davis

et al. 2010

annals

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Ann R Coll Surg Engl 2010; 92: 206-210 206Common bile duct (CBD) stones remain a considerable source of morbidity and mortality, and their presence should be considered in all patients presenting with symptomatic calculi. Intra-operative cholangiography (IOC) has been shown to be a sensitive and specific method of demonstrating bile duct stones; 1 however, it is time consuming, has resource implications and may result in unnecessary bile duct explorations due to false-positive examinations.Other methods for pre-operative assessment of the CBD have previously been evaluated. Magnetic resonance cholangiopancreatography (MRCP) is a sensitive, non-invasive method of imaging the biliary tree.2,3 However, it lacks the immediate therapeutic options available during IOC or endoscopic retrograde cholangiopancreatography (ERCP) and consumes the valuable MRI resource. ERCP, however, is an invasive procedure with morbidity and mortality rates Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis, and aimed to identify the factors most likely to predict the presence of CBD stones positively. PATIENTS AND METHODS Data from 501 consecutive patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gallstones, of whom 166 underwent IOC for suspected CBD stones, were prospectively collected. Suspicion of choledocholithiasis was based upon: (i) deranged liver function tests (past or present); (ii) history of jaundice (past or present) or acute pancreatitis; (iii) a dilated CBD or demonstration of CBD stones on imaging; or (iv) a combination of these factors. Patient demographics, intra-operative findings, complications and clinical outcomes were recorded. RESULTS Sixty-four cholangiograms were positive (39%). All indications for cholangiogram yielded positive results. Current jaundice yielded the highest positive predictive value (PPV; 86%). A dilated CBD on pre-operative imaging gave a PPV of 45% for CBD calculi; a history of pancreatitis produced a 26% PPV for CBD calculi. Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms. Of the 64 patients having a laparoscopic common bile duct exploration (LCBDE), four (6%) required endoscopic retrograde cholangiopancreatography (ERCP) for retained stones (94% successful surgical clearance of the common bile duct) and one (2%) for a bile leak. Of the 335 patients undergoing LC alone, three (0.9%) re-presented with a retained stone, requiring intervention. There were 12 (7%) requiring conversion to open operation. CONCLUSIONS A selective policy for intra-operative cholangiography yields acceptably high positive ...

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“…Similarly, Taylor et al. found it was effective and efficient in their regional non‐specialist unit and felt it was important for general surgeons to continue performing LBDE to maintain important surgical skills 20 …”

Section: Discussionmentioning

confidence: 99%

Results of laparoscopic bile duct exploration via choledochotomy

Kelly

2010

ANZ Journal of Surgery

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Laparoscopic Bile Duct Exploration: Results of 160 Consecutive Cases With 2‐year Follow Up

Cited by 24 publications

References 31 publications

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis

Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones

Results of laparoscopic bile duct exploration via choledochotomy

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