Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration
Open Access
- 11 December 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in Langenbecks Archives Of Surgery
- Vol. 404 (8), 985-992
- https://doi.org/10.1007/s00423-019-01845-3
Abstract
Purpose Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy. Methods Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction. Results One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III–IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively. Conclusions LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.Keywords
This publication has 37 references indexed in Scilit:
- Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysisSurgical Endoscopy, 2018
- The Safety and Efficacy of Single-Operator Cholangioscopy in the Treatment of Difficult Common Bile Duct Stones after Failed Conventional ERCP.Journal of the Canadian Association of Gastroenterology, 2018
- Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile ductCochrane Database of Systematic Reviews, 2018
- Laparoscopic Versus Endoscopic Management of Choledocholithiasis in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-analysisJournal of Laparoendoscopic & Advanced Surgical Techniques, 2014
- Surgical versus endoscopic treatment of bile duct stonesPublished by Wiley ,2012
- Endoscopic Removal of Large Common Bile Duct Stones: Time to Arm the Laser?Digestive Diseases and Sciences, 2012
- Laparoscopic common bile duct exploration and holmium laser lithotripsy: a novel approach to the management of common bile duct stonesSurgical Endoscopy, 2010
- Use of the laparoscopic–endoscopic approach, the so-called “rendezvous” technique, in cholecystocholedocholithiasisSurgical Endoscopy, 2006
- Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)Best Practice & Research Clinical Gastroenterology, 2006
- A Prospective Study of Common Bile Duct Calculi in Patients Undergoing Laparoscopic CholecystectomyAnnals of Surgery, 2004