Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

López-López, Víctor; Gil-Vazquez, Pedro José; Ferreras, D.; Nassar, Ahmad H. M.; Bansal, Virinder Kumar; Topal, Baki; Zhu, Jiegao; Chuang, Shu‐Hung; Jorba, Rosa; Bekheit, Mohamed; Martínez‐Cecilia, David; Parra-Membríves, Pablo; Sgourakis, George; Mattila, Anne; Bove, Aldo; Quaresima, Silvia; González, Javier Ernesto Barreras; Sharma, Anil; Ruiz, Juan José Vanegas; Sánchez‐Bueno, Francisco; Robles, R; Martínez‐Isla, Alberto

doi:10.1002/jhbp.1123

Cited by 12 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the adoption of the surgical approach seems to be increasing and relatively large numbers of centres are reporting their techniques and results. A recent multicentre survey of 17 centres in 9 countries reported 3950 bile duct explorations, including a major contribution by this unit’s series, and concluded that LBDE is safe and effective when performed by experienced teams [ 7 ]. As a number of international societies agree that in the presence of the expertise and equipment, the results of the laparoscopic approach can be superior to the staged management, the authors recommended the development of more training programs.…”

Section: Discussionmentioning

confidence: 99%

A proposed difficulty grading system for laparoscopic bile duct exploration: benefits to clinical practice, training and research

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background A gap remains between the mounting evidence for single session management of bile duct stones and the adoption of this approach. Laparoscopic bile duct exploration (LBDE) is limited by the scarcity of training opportunities and adequate equipment and by the perception that the technique requires a high skill-set. The aim of this study was to create a new classification of difficulty based on operative characteristics and to stratify postoperative outcomes of easy vs. difficult LBDE irrespective of the surgeon’s experience. Methods A cohort of 1335 LBDEs was classified according to the location, number and size of ductal stones, the retrieval technique, utilisation of choledochoscopy and specific biliary pathologies encountered. A combination of features indicated easy (Grades I and II A & B) or difficult (Grades III A and B, IV and V) transcystic or transcholedochal explorations. Results 78.3% of patients with acute cholecystitis or pancreatitis, 37% with jaundice and 46% with cholangitis had easy explorations. Difficult explorations were more likely to present as emergencies, with obstructive jaundice, previous sphincterotomy and dilated bile ducts on ultrasound scans. 77.7% of easy explorations were transcystic and 62.3% of difficult explorations transductal. Choledochoscopy was utilised in 23.4% of easy vs. 98% of difficult explorations. The use of biliary drains, open conversions, median operative time, biliary-related complications, hospital stay, readmissions, and retained stones increased with the difficulty grade. Grades I and II patients had 2 or more hospital episodes in 26.5% vs. 41.2% for grades III to V. There were 2 deaths in difficulty Grade V and one in Grade IIB. Conclusion Difficulty grading of LBDE is useful in predicting outcomes and facilitating comparison between studies. It ensures fair structuring and assessment of training and progress of the learning curve. LBDEs were easy in 72% with 77% completed transcystically. This may encourage more units to adopt this approach. Graphical abstract

show abstract

Section: Discussionmentioning

confidence: 99%

A proposed difficulty grading system for laparoscopic bile duct exploration: benefits to clinical practice, training and research

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another recent retrospective multicenter study including 3950 cases of LCBDE showed a prevalence of the transcystic approach (63.1%), with a failure rate of 4% and a morbidity rate of 13.6%. However, most importantly, a survey defined a high rate (82.4%) of poor or very poor current training[ 41 ]. For primary CBD stones without cholelithiasis, LCBDE preserving the gallbladder has been recently reported[ 42 ].…”

Section: Managementmentioning

confidence: 99%

Current management of concomitant cholelithiasis and common bile duct stones

Pavlidis¹,

Pavlidis²

2023

World J Gastrointest Surg

View full text Add to dashboard Cite

The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one- or two-stage procedure. It basically includes either laparoscopic cholecystectomy (LC) with laparoscopic common bile duct (CBD) exploration (LCBDE) in the same operation or LC with preoperative, postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy (ERCP-ES) for stone clearance. The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC, preferably on the next day. In cases where preoperative ERCP-ES is not feasible, the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated. The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES. However, there is no consensus on the superiority of laparoendoscopic rendezvous. This is equivalent to a traditional two-stage procedure. Endoscopic papillary large balloon dilation reduces recurrence. LCBDE and intraoperative ERCP have similar good outcomes. The risk of recurrence after ERCP-ES is greater than that after LCBDE. Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones. The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage, but the transcystic approach must be used where possible. LCBDE is a safe and effective choice when performed by an experienced surgeon. However, the requirement of specific equipment and advanced training are drawbacks. The percutaneous approach is an alternative when ERCP fails. Surgical or endoscopic reintervention for retained stones may be needed. For asymptomatic CBD stones, ERCP clearance is the first-choice method. Both one-stage and two-stage management are acceptable and can ensure improved quality of life.

show abstract

“…В последнее время лапаросĸопичесĸое лечение холецисто-и холедохолитиаза является общепринятым, однако риски и преимущества одноэтапного и двухэтапного подходов к лечению билиарного литиаза противоречивы и продолжают «Хирургия. Восточная Европа», 2023, том 12, № 4 обсуждаться [12,21,36]. Лечение, основанное на одно-или двухэтапной процедуре, включает либо лапаросĸопичесĸую холецистэĸтомию (ЛХЭ) с лапаросĸопичесĸой ревизией общего желчного протока (ОЖП) в рамках одной операции либо ЛХЭ с предоперационной, послеоперационной и даже интраоперационной ЭРХПГ.…”

Section: результатыunclassified

“…Безопасность лапароскопической ревизии желчных протоков подтверждает ретроспеĸтивное межинституциональное исследование среди 17 центров с доказанным опытом проведения лапароскопий [21]. Всего было проанализировано 3950 процедур, самым частым показанием была желтуха (58,8%).…”

Section: результатыunclassified

The Role of Diapeutical Methods and X-Ray Surgery in the Treatment of Complicated Forms of Cholelithiasis

Нурмурзаев,

Жураев,

Хамидов

et al. 2023

Хирургия. Восточная Европа

View full text Add to dashboard Cite

Введение. Лечение осложнений желчнокаменной болезни представляет собой актуальную проблему современной билиарной хирургии вследствие широкого распространения патологии и возможных тяжелых исходов для пациентов. Цель. Анализ возможностей применения эндоскопических транскутанных диапевтичесĸих и рентгенохирургических методов в лечении данной патологии в современных условиях. Материалы и методы. Для достижения указанной цели был проведен анализ научных публикаций в рецензируемых профильных медицинских изданиях по применению малоинвазивных методов лечения под ультразвуковым и рентгенологическим контролем, а также интраоперационных эндоскопических методик при осложненном течении холедохолитиаза. Поиск проводился в базах данных inLibrary, Scopus, PubMed и Google Scholar, отбирались аналитические, ретроспективные, проспективные исследования, работы смешанного дизайна, систематические обзоры и национальные исследования за 2018–2023 гг. Результаты. Рассмотрены преимущества, возможные сложности и меры их преодоления при применении мини-инвазивных чрескожных и эндоскопических методов в лечении осложнений билиарного литиаза. Проанализированы возможные хирургические тактики при лечении осложнений желчнокаменной болезни, слабые и сильные стороны такого выбора, основные рекомендации по оптимизации лечения. Сделаны выводы о высокой эффективности сочетанной ультразвуковой, рентгеновской и эндоскопической визуализации. Предложены меры по обеспечению безопасного широкого применения диапевтичесĸих методов в специализированных медицинских центрах. Заключение. Рациональное применение спектра рассмотренных методик позволит существенно улучшить результаты лечения пациентов, снизить летальность, уменьшить время стационарного лечения и реабилитации этих пациентов, а также снизить суммарные расходы на лечение. Introduction. The treatment of complications of cholelithiasis is a pressing issue in modern biliary surgery due to the wide spread of the pathology and possible severe outcomes for patients. Purpose. Analysis of the possibilities of using endoscopic transcutaneous diapeutical and X-ray surgical methods in the treatment of this pathology in modern conditions. Materialsandmethods.Toachievethestatedpurpose, ananalysisofscientificpublications in peer-reviewed specialized medical journals on the application of minimally invasive treatment methods under ultrasound and radiographic guidance, as well as intraoperative endoscopic techniques in complicated choledocholithiasis, was conducted. The search was conducted in the inLibrary, Scopus, PubMed, and Google Scholar databases, and analytical, retrospective, prospective studies, mixed-design studies, systematic reviews, and national studies from 2018–2023 were selected. Results. The advantages, potential challenges, and measures to overcome them in the application of minimally invasive percutaneous and endoscopic methods for treating complications of biliary lithiasis were examined. Possible surgical tactics in the treatment of complications of gallstone disease, their strengths and weaknesses, and key recommendations for treatment optimization were analyzed. Conclusions were drawn regarding the high effectiveness of combined ultrasound, radiographic, and endoscopic visualization. Measures were proposed to ensure the safe and wide application of diathermic methods in specialized medical centers. Conclusion. It is concluded that the rational application of the spectrum of the discussed techniques will significantly improve treatment outcomes, reduce mortality, decrease the duration of hospitalization and rehabilitation of these patients, as well as reduce the overall treatment costs.

show abstract

Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

Abstract: Background:Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the

Cited by 12 publications

References 31 publications

A proposed difficulty grading system for laparoscopic bile duct exploration: benefits to clinical practice, training and research

A proposed difficulty grading system for laparoscopic bile duct exploration: benefits to clinical practice, training and research

Current management of concomitant cholelithiasis and common bile duct stones

The Role of Diapeutical Methods and X-Ray Surgery in the Treatment of Complicated Forms of Cholelithiasis

Contact Info

Product

Resources

About