Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Cholangiography and Choledochoscopy

Cai, Haibo; Sun, Donglin; Sun, Yueming; Bai, Jianfeng; Zhao, Hang; Miao, Yi

doi:10.1007/s00268-011-1346-6

Cited by 50 publications

(50 citation statements)

References 24 publications

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“…We experienced three (6.7 %) clinically significant bile leakage. This is comparable to the bile leak rates of 2.0-4.5 % reported by others [12]. Fortunately, the transudative bile was completely drained by the suction catheter without localized or extensive peritonitis.…”

Section: Discussionsupporting

confidence: 86%

“…These data indicated primary closure following laparoscopic common bile duct reexploration for the patients with prior biliary surgery was also feasible choice. In our opinion, the indications for laparoscopic bile duct reexploration following primary closure are similar as LCBDE [12]: (1) Presence of choledocholithiasis without evidence of intrahepatic bile duct stones; (2) diameter of the CBD is >1 cm; (3) little inflammation or edema in the wall of CBD or sphincter of Oddi; (4) ensure all CBD stones are retrieved totally.…”

Section: Discussionmentioning

confidence: 99%

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Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

et al. 2016

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To assess feasibility of primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation, we retrospectively studied 50 patients with recurrent or residual common bile duct (CBD) stones who underwent laparoscopic biliary reoperation between June 2008 and June 2013. Endoscopic sphincterotomy (EST) was treated for all these patients and validated failed. They were divided into two groups. Primary closure following laparoscopic common bile duct exploration (LCBDE) was performed in 25 cases (group A); LCBDE plus T-tube drainage was performed in others (group B). The items of operation were compared. The duration of the operation in group A was shorter than that in group B (141 ± 85 vs 158 ± 71 min, p < 0.05), as was postoperative hospital stay (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05) and the times of postoperative gastrointestinal function recovery (16 ± 2.3 vs 23 ± 2.3 h, p < 0.05). Just one duodenum was damaged in group B. Postoperative clinically significant bile leakage occurred in two patients in group A and one case in group B. The median follow-up was 18 months. No postoperative pancreatitis, postoperative bleeding, bile peritonitis after T-tube removal, stricture of bile duct, and death occurred in the two groups. Just two cases in group B were verified residual stones after 1 month. Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation appears to be a minimally invasive, safe, feasible, and effective procedure when done by expert laparoscopic surgeons.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

et al. 2016

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“…However, the insertion of a T-tube is associated with a complication rate of 15%, which includes fluid and electrolyte disturbances, localized pain, a dislodged T-tube, biliary stricture, and bile leak when the T-tube is in situ or after its removal, without any significant differences between open and laparoscopic explorations [12,16,17]. This led several authors to perform laparoscopic primary duct closure after choledochotomy [18,19,20].…”

Section: Discussionmentioning

confidence: 99%

Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

et al. 2015

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Background: Choledocholithiasis is traditionally managed by endoscopic retrograde cholangiopancreatography or T-tube insertion following common bile duct exploration. This study examined the efficacy and safety of primary duct closure following laparoscopic common bile duct exploration (LCBDE) via choledochotomy. Methods: Between September 2011 and September 2013, 157 consecutive patients underwent LCBDE via choledochotomy. Results: Of 157 LCBDE procedures, 138 (87.9%) were successfully completed with primary closure of the choledochotomy. Eight patients (5.1%) underwent closure with T-tube drainage after choledochotomy and 11 patients (7.0%) were converted to open surgery. The biliary tree was free of stones at the end of surgery in 154 patients (98.1%). Postoperative bile leak occurred in 6 patients (3.8%). The median follow-up period was 18 (2-33) months, with no evidence of further bile duct stones or bile duct stricture in any patients. Univariable analysis revealed that successful duct clearance (p = 0.010) and diameter of the common bile duct (p < 0.001) were two significant risk factors for bile leak. Conclusions: Primary duct closure following LCBDE is effective and safe for the management of choledocholithiasis. The postoperative bile leak rate may be low in skilled laparoscopic surgeons with a careful selection of patients.

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“…The indications are as follows: 1) CBD stones secondary to gallbladder stones without intrahepatic bile duct stones; 2) no residual stones were confirmed in intra-/extra-hepatic bile duct by intraoperative choledochoscope; 3) the function of oddi sphincter was well and no evident edema or neoplasma occurred in the distal CBD; 4) the diameter of CBD was more than 8 mm in order to avoid postoperative bile duct stricture [20] [21]. The followings are considered as contraindication for primary closure: 1) extrahepatic bile duct multiple stones were not removed completely; 2) the diameter of CBD was less than 8 mm; 3) acute suppurative cholangitis with CBD wall severe edema; 4) stenosis or obstruction existed in the distal CBD; 5) server Mirizzi syndrome [22].…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of Primary Suture Following Three-Port Laparoscopic Common Bile Duct Exploration: A Report of 176 Cases

Li¹,

Cai²,

Sun³

et al. 2015

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Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Cholangiography and Choledochoscopy

Abstract: Laparoscopic primary closure of the CBD is safe and successful for the management of CBD stones. Application of IOC and choledochoscopy to ensure clearance of the CBD and careful suturing are essential for primary closure.

Cited by 50 publications

References 24 publications

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

Primary Closure Following Laparoscopic Common Bile Duct Reexploration for the Patients Who Underwent Prior Biliary Operation

Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy

Clinical Application of Primary Suture Following Three-Port Laparoscopic Common Bile Duct Exploration: A Report of 176 Cases

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