Laparoscopic transection choledochoduodenostomy

Abstract

Choledochoduodenostomy is a well-established procedure and is indicated in patients with multiple ductal calculi and dilated common bile duct (>or=2.0 cm) because these patients require drainage for good long-term results without recurrence of jaundice or cholangitis. The technique most commonly used is that of a side-to-side hand-sutured anastomosis between the supraduodenal common bile duct and the duodenum. The merit of this technique is its simplicity, although it is prone to duodenobiliary reflux and to occasional symptomatic inspissation with food debris causing cholangitis (sump syndrome). It is the technique that has been adopted by most centers for laparoscopic choledochoduodelaostomy. The alternative operation, transection choledochoduodenostomy, excludes the distal (transpancreatic) segment of the bile duct from the end-to-side anastomosis of the transected common bile duct with the second part of the duodenum. The long-term results of this procedure are excellent, and for this reason we have used it for laparoscopic drainage of the common bile duct in six elderly patients (four females and two males; age range, 61-72 years) with multiple occluding ductal calculi and grossly dilated bile duct. Three of these patients (including the one shown in the multimedia video) were admitted acutely with bacterial cholangitis and required emergency insertion of pigtail stent to overcome the acute septic illness. There were no conversions. The first operation lasted 4 h but the operating times in the last two patients were 2.0 and 2.5 h. The results have been excellent, with no deaths and a low postoperative morbidity (chest infection in one patient) and median postoperative hospital stay of 5 days.

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

“…cTnI is an inhibitory protein within the troponin-tropomyosin complex that regulates striated muscle contraction [ 21 ]. The troponin complex is released in damaged cardiac muscle and serum levels are sensitive markers of cardiac injury [ 21 , 22 ].…”

Laparoscopic exploration of bile ducts in patients with calculosis. indications, methods and first results

“…In cases of a long and narrow bladder duct, running parallel to the common hepatic duct and joining it in the formation of the CBD somewhere in the periampullary region, revision of the entire biliary tree is impossible, which is a clear indication to use choledochotomy as a method of approach. 6,7 Regarding the type of choledochotomy, there are basically two types described in the literature: longitudinal and transverse. The general principle is that the length of incision in choledochotomy should be between 1.2 and 2 cm.…”

“…The experience gained and the increased dexterity in laparoscopic suture skills allows the performance of one-step choledochoduodenostomy which is essentially an internal drainage in patients with residual stones and/or obstruction of the papilla of Vater. 2,4,6 A major drawback of choledochoduodenostomy is the occurrence of chronic cholangitis as a late complication in approximately 3-5% of the patients.…”

Open choldecho-enterostomy for common bile duct stones: Is it out of date in laparo-endoscopic era?

“…Reports on laparoscopic CDS have been published, but these procedures need considerable experience and expensive technologies. [56] The two most notable objections to CDS are the possibility of cholangitis and the presence of the symptoms produced by the so called “sump/blind sac” syndrome. Thus many authors suggested a CBD diameter larger than 16 mm precaution to allow a CDS with an opening no smaller than 14 mm in diameter.…”