Laparoscopic Choledochotomy in a Solitary Common Duct Stone: A Prospective Study

Abstract

Background Laparoscopic common bile duct exploration has all the advantages of minimal access and is also the most cost effective compared to the other options. Objective To study a profile on laparoscopic common bile duct exploration for a single common duct stone. Methods A total of 30 consecutive patients with solitary common bile duct stone attending our hospital over a period of one year were enrolled in the study. Laparoscopic common bile duct exploration was done by transductal route in all the patients. Results There were 18 females and 12 males with age ranging from 28 to 75 years. Jaundice was present in 12 (40%) patients. Twenty-four (80%) patients had raised alkaline phosphatase. The mean size of CBD on ultrasound was 11.55 mm. The mean size of calculus was 11.06 mm and was located in the distal CBD in 26 (86.7%) patients. The mean operative time was 158.4 ± 57.89 min. There were 8 (26.6%) conversions to open procedure. T-tube was used in 26 (86.7%) patients. The postoperative complications were hospital acquired chest infection in 3 (10%), surgical site infection in 3 (10%), acute coronary syndrome in one (3.3%), and bile leak after T-tube removal in one (3.3%) patient. Conclusions Laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone.

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

“…After LCD, the morbidity rate ranges from 4% to 26.7%, [ 8 , 46 , 62 ] similarly, after ERCP failure, LCD complication rate was 12.5%, 14.3% and 18.8% in Karaliotas et al, 2008 [ 41 ], ours and Karaliotas et al, 2015 [ 28 ] studies respectively, however, after ERCP failure, LCD in non-dilated CBD had 8.7% complication rate in Jinfeng et al, 2016 [ 32 ] study, on the other hand, the morbidity rate post-LCD ranged between 8.3% and 26.6% in Khaled et al, 2013 [ 68 ], Mattila et al, 2017 [ 65 ], Quaresima et al, 2017 [ 4 ], and Deo et al, 2018 [ 70 ] studies. Conversely, there was no major complication after LCD in Zhan et al, 2016 [ 7 ] study.…”

“…Despite advances in LCD, previous upper abdominal operations, dense adhesions, impacted, multiple stones, bleeding, and technical difficulties are causes of conversion to open surgery [ 1 , 66 , 70 , 71 ]. In similar, There were 4 cases of conversion in our series due to adhesions (1 patient), bleeding (1 patient), and technical failure (2 patients); this conversion reached 16%(4/25), however, the LCD done after ERCP failure conversion rate was 34.3% and 34.4% in Karaliotas et al, 2015 [ 28 ], and Karaliotas et al, 2008 [ 41 ] studies respectively, while it reached 4.35% in Jinfeng et al, 2016 [ 32 ] study that was performed in non-dilated CBD after endoscopic failure, and reached 10% in Khan et al, 2015 [ 64 ] study for impacted stones, on the other hand, LCD conversion to open ranged between 0.8% and 26.6% in Tokumura et al, 2002 [ 66 ], Grubnik et al, 2012 [ 67 ], Jinfeng et al, 2016 [ 32 ].…”

“…In similar, There were 4 cases of conversion in our series due to adhesions (1 patient), bleeding (1 patient), and technical failure (2 patients); this conversion reached 16%(4/25), however, the LCD done after ERCP failure conversion rate was 34.3% and 34.4% in Karaliotas et al, 2015 [ 28 ], and Karaliotas et al, 2008 [ 41 ] studies respectively, while it reached 4.35% in Jinfeng et al, 2016 [ 32 ] study that was performed in non-dilated CBD after endoscopic failure, and reached 10% in Khan et al, 2015 [ 64 ] study for impacted stones, on the other hand, LCD conversion to open ranged between 0.8% and 26.6% in Tokumura et al, 2002 [ 66 ], Grubnik et al, 2012 [ 67 ], Jinfeng et al, 2016 [ 32 ]. Jinfeng et al, 2016 [ 1 ], Quaresima et al, 2017 [ 4 ], Korontzi et al, 2012 [ 18 ], Mattila et al, 2017 [ 65 ], and Deo et al, 2018 [ 70 ] studies. Conversely, there was no post-LCD conversion in Zhan et al, 2016 [ 7 ], Khaled et al, 2013 [ 68 ], and Vindal et al, 2015 [ 69 ] studies.…”

“…It can be done when complete stone extraction is ensured during the operation especially with choledochoscopy [ 66 , 82 ]. We used T-tube in 52.4% of our LCD patients; similarly, it was used in the range of 32.3% and 86.7% of patients in Herrero et al, 2013, [ 56 ] Tokumura et al, 2002, [ 66 ] Grubnik et al, 2012, [ 67 ] Quaresima et al,2017, [ 4 ] Paganini et al, 2005, [ 61 ] Karaliotas et al, 2008, [ 41 ] Mattila et al, 2017, [ 65 ] and Deo et al, 2018 [ 70 ] studies. On the other hand, primary closure of CBD was performed in 42.9% of our LCD patients, in similar; its use ranged from 5.1% to 100% of patients in Paganini et al, 2005 [ 61 ], Tokumura et al, 2002 [ 66 ], Quaresima et al, 2017 [ 4 ], Grubnik et al, 2012 [ 67 ], Herrero et al, 2013 [ 56 ], and Koc et al, 2013 [ 34 ] studies.…”

Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?

“…Choledochotomy and T-tube insertion were needed. [30,31] The purpose of T-tube insertion is to decompress the biliary tract and remove residual stones. However, T-tube-related complications are relatively common, and 10% to 15% of patients may experience complications, such as fluid and electrolyte imbalance, bile leakage, infection at the T-tube site, and T-tube displacement.…”