Management of Choledocholithiasis

Way, Lawrence W.; Admirand, William H.; Dunphy, J. Englebert

doi:10.1097/00000658-197209000-00011

Cited by 262 publications

(70 citation statements)

References 28 publications

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“…IOC was historically utilized in open procedures to aid CBD stone detection and its routine use was debated long before the birth of LC [48]. However, IOC during LC provides the additional benefit of providing a ''road map'' for operative dissection.…”

Section: Role Of Intraoperative Cholangiogram (Ioc): a Literature Ovementioning

confidence: 99%

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

et al. 2012

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Laparoscopic cholecystectomy is now one of the most frequently performed abdominal surgical procedures in the world. The most common major complication is bile duct injury, which can have catastrophic repercussions for patients and it has been suggested that intraoperative cholangiography may reduce the rate of bile duct injury. Whether this procedure should be performed routinely is still an active subject of debate. We discuss the available evidence and likely implications for the future.

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Section: Role Of Intraoperative Cholangiogram (Ioc): a Literature Ovementioning

confidence: 99%

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

et al. 2012

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“…In the case of diagnostic doubt, the external biliary drainage may be the best option because it allows the possible postoperative diagnostic confirmation, and if so, helps the additional endoscopic procedure (31) . The risk to treating calculi less than 3 mm must be balanced with the risk of arising complications (80) . Treatment in such cases should only be indicated in those with history of acute biliary pancreatitis.…”

Section: Choice Of Technical Proceduresmentioning

confidence: 99%

“…This emphasizes the role of routine intraoperative cholangiography as the only way to establish diagnosis in these circumstances (35,49,65) . Classically, the surgery by laparotomy for access to the main biliary tract constituted the standard treatment for choledocholithiasis, preceding choledocholithotomy and external biliary drainage (80) . In the 70's, the introduction of the retrograde endoscopic cholangiography and subsequently papillotomy permitted a therapeutic alternative, especially in those patients that had previously been subject to cholecystectomy (12,17,23,44) .…”

Section: Introductionmentioning

confidence: 99%

Common bile duct stones: analysis of the videolaparoscopic surgical treatment

Santo

Domene

Riccioppo

et al. 2012

Arq. Gastroenterol.

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-Context -About 9% of the Brazilian population has gallstones and the incidence increases significantly with aging. The choledocholithiasis is found around 15% of these patients, and a third to half of these cases presented as asymptomatic. Once the lithiasis in the common bile duct is characterized through intraoperative cholangiography, the laparoscopic surgical exploration can be done through the transcystic way or directly through choledochotomy. Objective -To evaluate the results and outcomes of the laparoscopic treatment of common bile duct lithiasis. Methods -Seventy consecutive patients were evaluated. They prospectively underwent the treatment of the lithiasis in the common bile duct and the exploration ways were compared according to the following parameters: criteria on their indication, success in the clearance, surgical complications. It was verified that about ½ of the choledocholithiasis carriers did not show any expression of predictive factors (clinical antecedents of jaundice and/or acute pancreatitis, compatible sonographic data and the pertaining lab tests). The laparoscopic exploration through the transcystic way is favored when there are no criteria for the practice of primary choledochotomy, which are: lithiasis in the proximal bile duct, large (over 8 mm) or numerous calculi (multiple calculosis). Results -The transcystic way was employed in about 50% of the casuistic and the choledochotomy in about 30%. A high success rate (around 80%) was achieved in the clearance of the common bile duct stones through laparoscopic exploration. The transcystic way, performed without fluoroscopy or choledochoscopy, attained a low rate of success (around 45%), being 10% of those by transpapilar pushing of calculi less than 3 mm. The exploration through choledochotomy, either primary or secondary, if the latter was performed after the transcystic route failure, showed high success rate (around 95%). When the indication to choledochotomy was primary, the necessity for choledochoscopy through choledochotomy to help in the removal of the calculi was 55%. However, when choledochotomy was performed secondarily, in situations where the common bile duct diameter was larger than 6 mm, the use of choledochoscopy with the same purpose involved about 20% of the cases. There was no mortality in this series. Conclusion -The laparoscopic exploration of the common bile duct was related to a low rate of morbidity. Therefore, the use of laparoscopy for the treatment of the lithiasis in the common bile duct depends on the criteria for the choice of the best access, making it a safe procedure with very good results. HEADINGS -Choledocholithiasis. Laparoscopy. Cholangiography.

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“…Based on epidemiological evidence the most common bile duct stones originate in the gallbladder. 1,2 Ten percent to 15% of the patients with cholecystectomy experience postcholecystectomy syndrome. 3 Cystic duct stones are involved in post-cholecystectomy pain, failure of insertion of on-table cholangiogram (OTC) catheter and the subsequent development of common bile duct (CBD) stones.…”

Section: Introductionmentioning

confidence: 99%

Value of routine milking of cystic duct during laparoscopic cholecystectomy

et al. 2017

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Background: Cystic duct stones (CDS) although they are occasionally encountered during laparoscopic cholecystectomy (LC) and are not detected easily by preoperative investigations however it is worthy to detect them intra-operatively as they will decrease the incidence of postcholecystectomy pain and they will alarm us to the more serious common bile duct (CBD) stones. So, we aimed at this study to evaluate the role of cystic duct milking in detection of cystic duct stones and its significance.Methods: This study was performed on 150 cases with calcular cholecystitis at Menofia University hospital in the period from August 2015 to May 2017. All patients had undergone LC, cystic duct milking. On table cholangiogram was done for cases that showed CDS.Results: CDS were detected in 28 cases, preoperative investigations failed to detect any of them however retrospectively 19 cases (67.8%) of them revealed to have mild transient liver functions derangement associated with acute right hypochondrial pain. Wide cystic duct (more than 4 mm) was recorded in 3 cases (10.7%) out of 28 cases that showed CDS. The incidence of association of cystic duct stones and CBD stones was found in 10 cases (35.7%).Conclusions: CDS are occasionally encountered during LC. They can be removed easily by just milking of cystic duct before clipping. The benefit is to decrease the incidence of post-cholecystectomy pain as well as it alerts us towards the more serious CBD stones. So on-table cholangiogram at that time becomes mandatory to avoid missed stone.

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Management of Choledocholithiasis

Abstract: SINCE CHOLEDOCHOLITHIASIS is responsible for much of the serious morbidity of gallstone disease the detection and elimination of stones within the common bile duct are major objectives of biliary surgery. Various strategies can be used to achieve these goals. For

Cited by 262 publications

References 28 publications

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating?

Common bile duct stones: analysis of the videolaparoscopic surgical treatment

Value of routine milking of cystic duct during laparoscopic cholecystectomy

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