Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta‐analysis

Hajibandeh, Shahin; Hajibandeh, Shahab; Sarma, Diwakar Ryali; Balakrishnan, Sankar; Eltair, Mokhtar; Mankotia, Rajnish; Budhoo, Misra; Kumar, Yogesh

doi:10.1007/s00268-019-05005-y

Cited by 32 publications

(26 citation statements)

References 47 publications

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“…The referencing order of the studies included in Table 2 starts from the most recently published papers. 19-54 Grading of the reviewed evidence was based on the content of Table 3. Statistical difference significance was considered to be P ≤ .05.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

Marks

Samaraee

2020

The American Surgeon

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Introduction Endoscopic and open surgical interventions are widely implemented as the standard practice in common bile duct exploration. However, the laparoscopic approach has been also reported to have comparative/superior outcomes in this concept. This has created an ongoing debate about the ideal approach to adopt in practice. Methods A systematic review of the published evidence over the last decade that has looked into the outcomes of laparoscopic exploration of the common bile duct through transductal and transcystic approaches. Results Our systematic review included 36 relevant papers. The majority were based on nonrandomized protocols conducted in single centers with high expertise. The data analysis showed that laparoscopic common bile duct exploration through both approaches was successful in more than 84% of the patients, with an average length of hospital stay of 5.6 days. Conversion to open surgery was reported in 5%-8% of the patients, and the bile leak rates from the more recent studies was 0%-12%, with mortality figures of 0%-1.3%. The outcomes were statistically in favor of the transcystic route when compared to the transductal route from the viewpoints of bile leak rates, mean operative time, duration of hospital stay and morbidity. Conclusion In experienced hands, both laparoscopic approaches in common bile duct exploration are safe in patients who are clinically fit to have this intervention. It is associated with a statistically significant lower overall morbidity and shorter duration of hospital stay when compared to open surgery. Relevant up-to-date high-quality randomized trials are unavailable.

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Section: Methodsmentioning

confidence: 99%

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

Marks

Samaraee

2020

The American Surgeon

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“…These studies confirmed that LCBDE+LC using a transductal approach is safe and feasible for the management of CBD stones after gastrectomy. However, conventional LCBDE (ie, a transductal approach using a T‐tube, choledochoscopy, or primary closure) is associated with various complications, including bile duct stricture, bile leakage, prolonged biliary fistula, bleeding, and possible peritonitis after T‐tube removal 9,10 …”

Section: Discussionmentioning

confidence: 99%

“…According to a systematic review and meta‐analysis of 2938 patients, the overall perioperative complication rate of LCBDE+LC by the transductal approach was 13.7%, and the biliary complication rate was 7.0% 9 . In addition, history of gastrectomy represents a risk factor for severe intra‐abdominal adhesions around the hepatoduodenal ligament.…”

Section: Discussionmentioning

confidence: 99%

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One‐stage fluoroscopy‐guided laparoscopic transcystic papillary balloon dilation and laparoscopic cholecystectomy in patients with cholecystocholedocholithiasis who previously had undergone gastrectomy for gastric cancer

Kamada

Ohdaira

Takeuchi

et al. 2020

Asian J Endoscop Surgery

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Background Patients with a history of gastrectomy have a higher incidence of cholecystocholedocholithiasis (CCL) and related morbidities than the general population. However, the management of common bile duct (CBD) stones with endoscopic retrograde cholangiopancreatography is challenging in patients after Roux‐en‐Y or Billroth II reconstruction because of the altered gastrointestinal anatomy. The aim of the current study was to evaluate the safety and efficacy of one‐stage laparoscopic transcystic papillary balloon dilation and laparoscopic cholecystectomy (LTPBD+LC) in patients with previous gastrectomy for gastric cancer. Methods This retrospective cohort study included five patients with CCL who had previously undergone gastrectomy. All five underwent LTPBD+LC between May 2015 and February 2020 at our institution. The primary end‐point was complete clearance of the CBD stones. Results Of the 311 patients who had undergone gastrectomy for gastric cancer from December 2009 to December 2018 at our institution, six (1.9%) were later diagnosed with CCL. Five of the six patients did not need emergency biliary drainage and underwent conservative therapy and subsequent elective LTPBD+LC. LTPBD+LC was successfully performed in all cases. None of the patients required conversion to open surgery. The rate of complete clearance of the CBD stones was 100%. The mean operative time of the entire procedure was 126 minutes (range, 102‐144 minutes), and the mean blood loss was 12.4 mL (range, 1‐50 mL). There were no major perioperative complications, and the mean length of postoperative hospital stay was 4.2 days (range, 3‐7 days). Conclusion One‐stage LTPBD+LC may be a feasible procedure for patients with CCL who have previously undergone gastrectomy for gastric cancer.

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“…Several studies have reported the benefits of TC over TD LCBDE [6,7,25,26]. Although CBD clearance rates are similar between TC and TD approaches, TC LCBDE has lower overall complications, biliary complications, bloods loss and reduced length of hospital stay.…”

Section: Discussionmentioning

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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Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta‐analysis

Cited by 32 publications

References 47 publications

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years

One‐stage fluoroscopy‐guided laparoscopic transcystic papillary balloon dilation and laparoscopic cholecystectomy in patients with cholecystocholedocholithiasis who previously had undergone gastrectomy for gastric cancer

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

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