Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis
Abstract Background Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure mi...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s12893-020-00705-y |
| _version_ | 1819169626345439232 |
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| author | Xiao-Bin Yang An-Shu Xu Jian-Gang Li Yong-Ping Xu De-Song Xu Chao-Chun Fu Da-Bo Deng Jie Li Ma-Zhong Zhang |
| author_facet | Xiao-Bin Yang An-Shu Xu Jian-Gang Li Yong-Ping Xu De-Song Xu Chao-Chun Fu Da-Bo Deng Jie Li Ma-Zhong Zhang |
| author_sort | Xiao-Bin Yang |
| collection | DOAJ |
| description | Abstract Background Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence. Methods In this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient’s own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery. Results Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later. Conclusions The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis. |
| first_indexed | 2024-12-22T19:22:29Z |
| format | Article |
| id | doaj.art-63cb1c693de740c4a1e3c484c6416e20 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-22T19:22:29Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-63cb1c693de740c4a1e3c484c6416e202022-12-21T18:15:20ZengBMCBMC Surgery1471-24822020-03-012011710.1186/s12893-020-00705-yDilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasisXiao-Bin Yang0An-Shu Xu1Jian-Gang Li2Yong-Ping Xu3De-Song Xu4Chao-Chun Fu5Da-Bo Deng6Jie Li7Ma-Zhong Zhang8Department of General Surgery, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of Anesthesiology, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of General Surgery, The First People’s HospitalDepartment of Anesthesiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of MedicineAbstract Background Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence. Methods In this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient’s own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery. Results Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later. Conclusions The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.http://link.springer.com/article/10.1186/s12893-020-00705-yCystic ductCholelithiasisSecondary choledocholithiasisCommon bile duct explorationSafetyEfficiency |
| spellingShingle | Xiao-Bin Yang An-Shu Xu Jian-Gang Li Yong-Ping Xu De-Song Xu Chao-Chun Fu Da-Bo Deng Jie Li Ma-Zhong Zhang Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis BMC Surgery Cystic duct Cholelithiasis Secondary choledocholithiasis Common bile duct exploration Safety Efficiency |
| title | Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| title_full | Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| title_fullStr | Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| title_full_unstemmed | Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| title_short | Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| title_sort | dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis |
| topic | Cystic duct Cholelithiasis Secondary choledocholithiasis Common bile duct exploration Safety Efficiency |
| url | http://link.springer.com/article/10.1186/s12893-020-00705-y |
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