Five-Year Experience with Transcystic Laparoscopic Common Bile Duct Exploration
- 1 December 2022
- journal article
- research article
- Published by Mary Ann Liebert Inc in Journal of Laparoendoscopic & Advanced Surgical Techniques
- Vol. 33 (3), 276-280
- https://doi.org/10.1089/lap.2022.0408
Abstract
Background: Common bile duct (CBD) stones associated with cholecystitis can be treated by single-stage CBD exploration at the time of cholecystectomy or a two-stage approach with endoscopic stone extraction before or after cholecystectomy. The ideal management remains a matter of debate. The aim of this study is to analyze our outcomes with transcystic laparoscopic common bile duct exploration (LCBDE). Material and Methods: A retrospective review of patients who underwent transcystic LCBDE between 2015 and 2019 was performed. Results: A total of 106 patients underwent transcystic LCBDE over 5 years. We performed 1192 laparoscopic cholecystectomies with cholangiograms from March 2015 to December 2019. Fifteen patients had a preoperative endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones seen on magnetic resonance cholangiopancreatography that during laparoscopic cholecystectomy with intraoperative cholangiogram (IOC), there were stones and/or sludge found in the CBD, which required clearance through a transcystic approach. Of the 91 patients who did not have a preoperative ERCP, clearance of the CBD was successful through a transcystic approach in 78 patients (86%). In the 13 patients that intraoperative clearance was not achieved (n = 13, 14%), a postoperative ERCP was performed. A total of 28 patients underwent either pre- or postoperative ERCP (n = 28, 26%). Choledochotomy was not performed in any of the patients. The mean operative time was 127 minutes (127 ± 48). The mean hospital length of stay (LOS) was 4 days (3.9 ± 2.8) with a median LOS of 3 days. Complications observed include wound infection (n = 2, 2%), pancreatitis after ERCP (n = 1, 1%), pneumonia (n = 1, 1%), and right hepatic duct injury (n = 1, 1%). Conclusion: Transcystic LCBDE is an effective and safe option for treatment of CBD stones. While a transcystic approach does not guarantee clearance of the CBD, it avoids the morbidity associated with a choledochotomy and can often prevent patients from having to undergo an additional procedure.Keywords
This publication has 13 references indexed in Scilit:
- Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysisSurgical Endoscopy, 2018
- Laparoscopic common bile duct explorationSurgical Endoscopy, 2017
- Nationwide trends of hospital admissions for acute cholecystitis in the United StatesGastroenterology Report, 2016
- Natural Course vs Interventions to Clear Common Bile Duct StonesJAMA Surgery, 2014
- Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injuryBritish Journal of Surgery, 2014
- Two-stagevssingle-stage management for concomitant gallstones and common bile duct stonesWorld Journal of Gastroenterology, 2012
- Lower Rate of Major Bile Duct Injury and Increased Intraoperative Management of Common Bile Duct Stones after Implementation of Routine Intraoperative CholangiographyJournal of the American College of Surgeons, 2011
- Are liver function tests, pancreatitis and cholecystitis predictors of common bile duct stones? Results of a prospective, population-based, cohort study of 1171 patients undergoing cholecystectomyHPB, 2011
- Guidelines on the management of common bile duct stones (CBDS)Gut, 2008
- A simple scoring system for predicting bile duct stones in patients with cholelithiasisJournal of Gastrointestinal Surgery, 2001