Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy

Takeuchi, Hiromi; Umezawa, Akihiro; Cao, Hui; Sakamoto, Nobuhide; Imaoka, Yoichi; Ouchi, Akihiko; Yamamoto, Kyoji

doi:10.1007/s005340200020

Cited by 88 publications

(96 citation statements)

References 23 publications

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“…Indeed, these complications were observed in a case series of choledochotomy in 42% of patients [8][9][10]. In the present study no postoperative pancreatitis was observed, while bile leakage developed in one patient only.…”

Section: Discussionsupporting

confidence: 54%

“…However, other series did not show such results [3,4]. The rate of residual stones after laparoscopic treatment ranges from 2.6% to 8% (mean 5%) and is equivalent to that of open surgery [3,7,8]. The transcystic approach, which is recently preferred in laparoscopic CBD exploration, is used in 26-93% (mean 71%) of cases, with a success rate ranging from 74% to 98% [7,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Grubnik¹,

Ткаченко²,

Vorotyntseva³

2011

Videosurgery and Other Miniinvasive Techniques

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years (range 27 to 87 years). There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients). Group II: open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA) classification; ASA II -109 patients, ASA III -59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCP) in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. Results: The mean duration of laparoscopic procedures was 82 min (range 40-160 min). The mean duration of open procedures was 90 min (range 60-150 min). Mean blood loss was much lower in the laparoscopic

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Grubnik¹,

Ткаченко²,

Vorotyntseva³

2011

Videosurgery and Other Miniinvasive Techniques

View full text Add to dashboard Cite

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“…In these unclear situations both transcystic laparoscopic CBD exploration and sequential ERCP-ES are questionable as often related to dense biliary sludge associated with stenosis of the papilla in which ES is certainly the safest solution for the patient. The laparoscopic CBD exploration normally consists of major biliary surgery and needs higher laparoscopic skills and prolongs the duration of the entire operation also increasing the overall risk for the patient [18,19,27] . The mean prolongation of the time of RV is nor mally shor ter than those repor ted for totally laparoscopic CBD exploration [27,28] .…”

Section: Discussionmentioning

confidence: 99%

“…The laparoscopic CBD exploration normally consists of major biliary surgery and needs higher laparoscopic skills and prolongs the duration of the entire operation also increasing the overall risk for the patient [18,19,27] . The mean prolongation of the time of RV is nor mally shor ter than those repor ted for totally laparoscopic CBD exploration [27,28] . This difference becomes more evident for those patients with multiple large stones and sludge and problems at the papilla.…”

Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work

G¹,

Barbagallo²,

Blasi³

et al. 2008

WJG

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AIM:To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS:Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. R E S U LT S :T h e f e a s i b i l i t y w a s 9 7. 5 % a n d t h e effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone's recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the cases. C O N C L U S I O N :S i m u l t a n e o u s R V c a r r i e s h i g h effectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

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“…These outcomes are relatively similar to those observed in other studies. 5,6,8,10,13 According to the data from multivariate analysis, the serum BIL and the presence of MRFs were significantly associated with adverse outcomes. The presence of toxic substances, such as BIL and bile salts, impaired liver function, and altered nutritional status due to obstructive jaundice have been characterized as factors for the development of complications, including acute renal failure, cardiovascular depression, hemorrhage from vitamin K deficiency and septicaemia.…”

Section: Discussionmentioning

confidence: 99%

Celebrity traumatic deaths: Are gangster rappers really “gangsta”?

Ball

Dixon

Parry

et al. 2013

cjs

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Background: Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. Methods:We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evalu ate diagnostic accuracy. Results:We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula:According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. Conclusion:High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.Contexte : La chirurgie laparoscopique pour extraction de calculs biliaires logés dans le cholédoque diffère sur le plan technique de la cholédochotomie laparoscopique (CL) par approche transcystique avec ou sans drain biliaire. Toutefois, la CL est une intervention délicate, qui s'accompagne d'un taux de morbidité documenté plus élevé comparativement à l'extraction transcystique. Nous avons analysé rétrospectivement les facteurs de risque à l'égard d'une issue négative de la CL.Méthodes : Nous avons utilisé des modèles de régression logistique pour évaluer 4 catégories d'issue négative : issue négative globale, complications, conversion vers une chirurgie ouverte et échec de l'extraction chirurgicale. Nous avons calculé l'aire sous la courbe de la fonction d'efficacité du récepteur pour évaluer la précision diagnostique.Résultats : Nous avons inclus dans notre analyse 201 patients soumis à une CL. Une issue négative est survenue chez 48 patients (23,9 %), des complications chez 43 (21,4 %), la persistance des calculs chez 8 (4 %) et la conversion vers la laparotomie chez 7 (3,5 %). L'analyse multivariée a montré que la bilirubine totale ( Conclusion : Un taux de BIL élevé et la présence de FRM pourraient prédire l'issue négative chez des patients soumis à une CL.

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Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy

Cited by 88 publications

References 23 publications

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective, safe and simplifies the endoscopist’s work

Celebrity traumatic deaths: Are gangster rappers really “gangsta”?

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