Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi

Abstract

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique as an adjunct to laparoscopic common bile duct stone extraction is warranted.

Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) to remove common bile duct stones during routine laparoscopic cholecystectomy does not prolong hospitalization: a 2-year experience

“…Decker et al [13], in a study where they performed LCBDE in 100 patients with a primary closure of the CBD without any biliary drainage, had a median hospital stay of 8 days (range, 3-32). In their study, there were significant differences between the participating centers regarding their academic status-i.e., patients at the university hospital had a median hospital stay of 6 days (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], whereas the participating private centers had a median hospital stay of 9 days (range, 5-32). This is, in our opinion, an indication that LCBDE is an advanced technique that benefits from the infrastructure at highly specialized academic centers.…”

“…Even with these strict selection criteria, >10% of the preoperative ERCP were normal. Laparoscopic stone removal, by either the transcystic approach (small stones) or by common bile duct exploration (CBDE) via a choledochotomy, allows for a more selective approach to the removal of CBDS, and thus the avoidance of unnecessary preoperative ERCP [4,6,20,23]. The intraoperative approach also benefits the patient by reducing treatment from a two-step procedure to a singlestep procedure under general anesthesia.…”

A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones Lessons and limits from an initial experience of 92 patients

“…These procedures were perfectly well tolerated in our experience. But a 15% incidence of pancreatitis has been reported with papillary balloon dilatation [6,8,30] and electrohydraulic lithotripsy required a careful use in close contact with the CBDS to avoid hemobilia or bile duct perforation [3,7,11].…”

The role of endoscopic retrograde cholangiopancreatography in the laparoscopic era

“…Laparoscopic CBD stone extraction is successfully used to clear the bile duct in 77%-100% of the cases, with a complication rate in the vicinity of 12%, and a mortality rate of 0-2% [1, 4, 5, 12, 15, 16, 19, 20, 25, 26, 28, 29, 33-35, 44, 45, 47]. Common bile duct stones also can be removed by balloon dilatation of the sphincter of Oddi through a laparoscopic transcystic duct technique with an 85% success rate [4]. When encountered, large complicated stones can be managed safely and effectively with electrohydraulic lithotripsy [51].…”