World Journal of Laparoscopic Surgery

Register      Login

VOLUME 14 , ISSUE 2 ( May-August, 2021 ) > List of Articles

RESEARCH ARTICLE

Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases

Belén Martin Arnau, Manuel Rodriguez Blanco, Victor Molina Santos, Antonio Rabal Fueyo, Antonio Moral Duarte, Santiago Sánchez Cabús

Keywords : Cholangiopancreatography endoscopic retrograde, Choledocholithiasis, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration

Citation Information : Arnau BM, Blanco MR, Santos VM, Fueyo AR, Duarte AM, Cabús SS. Results Obtained with the Laparoscopic Approach to the Bile Duct for the Treatment of Choledocholithiasis in 101 Cases. World J Lap Surg 2021; 14 (2):119-125.

DOI: 10.5005/jp-journals-10033-1447

License: CC BY-NC 4.0

Published Online: 19-08-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The optimal treatment for choledocholithiasis (CLT) is currently the subject of debate, as there is no clear evidence that a two-step (endoscopic plus surgical) approach is superior to a one-step surgical procedure. Materials and methods: We analyzed the results obtained from 101 consecutive patients diagnosed with CLT using magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) scan undergoing cholecystectomy and laparoscopic exploration of the bile duct, carried out at our center between 2006 and 2019. In this analysis, special emphasis was made on the permanent resolution of the CLT and the associated complications. Results: The mean surgical time was 142 ± 36.7 minutes. In patients with a CLT diagnostic test more than 7 days previously, the presence of CLT was checked using intraoperative cholangiography (IOC), which was negative in 25% of patients, while in the rest, a primary exploration was performed using a choledochoscope via choledochotomy in 82.2% of patients and via the transcystic approach in two cases. A T-tube drain was inserted in 18.9% of patients. The conversion rate was 0.9%, due to a technical difficulty in removing the CLT in one patient. The laparoscopic approach treated the CLT permanently in 97/101 cases (96%), while four patients (3.9%) required postoperative endoscopic retrograde cholangiopancreatography (ERCP) due to residual cholelithiasis. A total of 15.8% of patients experienced a postoperative biliary fistula, which was resolved using conservative management in 86.7% of them, while two patients required surgical treatment and insertion of a percutaneous drain, respectively. The average postoperative stay duration was 6.5 ± 7.3 days. None of the patients showed signs of biliary stricture in the long-term postoperative follow-up. Conclusion: In our experience, the laparoscopic approach for one-step elective treatment of CLT is a safe option, with a very small number of complications and satisfactory short- and long-term results. Furthermore, despite preoperative identification of CLT, it helped to avoid unnecessary exploration of the bile duct in 25% of patients.


PDF Share
  1. Nahrwold D. The biliary system. In: Sabiston X, editor. Textbook of surgery. Philadelphia: WE Saunders; 1986.
  2. Way LW, Admirand WJ, Dunphy JE. Management of choledocholithiasis. Ann Surg 1972;176(3):347–359. DOI: 10.1097/00000658-197209000-00011.
  3. Petelin JB. Laparoscopic common bile duct exploration: lessons learned from >12 years experience. Surg Endosc 2003;17(11):1705–1715. DOI: 10.1007/s00464-002-8917-4.
  4. Escat J, Fourtanier G, Maigne C, et al. Choledochoscopy in common bile duct surgery for choledocholithiasis: a must. Am Surg 1985;51(3):166–167. PMID: 3977190.
  5. Fink AS. Current dilemmas in management of common duct stones. Surg Endosc 1993;7(4):285–291. DOI: 10.1007/BF00725941.
  6. Newman KD, Powell DM, Holcomb III GW. The management of choledocholithiasis in children in the era of laparoscopic cholecystectomy. J Pediatr Surg 1997;32(7):1116–1119. DOI: 10.1016/s0022-3468(97)90411-5.
  7. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–196. DOI: 10.1097/SLA.0b013e3181b13ca2.
  8. Traverso LW, Roush TS, Koo K. CBD stones-outcomes and costs. Laparoscopic transcystic techniques other than choledochoscopy. Surg Endosc 1995;9(11):1242–1244. PMID: 8553247.
  9. Liberman MA, Phillips EH, Carroll BJ, et al. Cost-effective management of complicated choledocholithiasis: laparoscopic transcystic duct exploration or endoscopic sphincterotomy. J Am Coll Surg 1996;182(6):488–494. PMID: 8646348.
  10. Phillips EH. Laparoscopic transcystic duct common bile duct exploration—outcome and costs. Surg Endosc 1995;9(11):1240–1242. PMID: 8553246.
  11. Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc 2007;21(12):2317–2321. DOI: 10.1007/s00464-007-9577-1.
  12. Hanif F, Ahmed Z, Samie MA, et al. Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc 2010;24(7):1552–1556. DOI: 10.1007/s00464-009-0809-4.
  13. Traverso LW. A cost-effective approach to the treatment of common bile duct stones with surgical versus endoscopic techniques. WB Saunders; 1996. p. 154–160.
  14. Perissat J, Huibregtse K, Keane FV, et al. Management of bile duct stones in the era of laparoscopic cholecystectomy. Br J Surg 1994;81(6):799–810. DOI: 10.1002/bjs.1800810606.
  15. Petelin J. Laparoscopic approach to common duct pathology. Surg Laparosc Endosc 1991;1(1):33–41. PMID: 1669374.
  16. Hunter J. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992;163(1):53–58. DOI: 10.1016/0002-9610(92)90252-m.
  17. Carroll BJ, Phillips EH, Daykhovsky L, et al. Laparoscopic choledochoscopy: an effective approach to the common duct. J Laparoendosc Surg 1992;2(1):15–21. DOI: 10.1089/lps.1992.2.15.
  18. Sackier JM, Berci G, Pas-Partlow M. Laparoscopic transcysticcholedochotomy as an adjunct to laparoscopic cholecystectomy. Am Surg 1991;57(5):323–326. PMID: 1828133.
  19. Jacobs M, VCerdeja JC, Goldstein HS. Laparoscopic choledocho-lithotomy. Jnl Laparoendosc Surg 1991;1(2):79–82. DOI: 10.1089/lps.1991.1.79.
  20. Quattlebaum JK, Flanders HD. Laparoscopic treatment of common bile duct stones. Surg Laparosc Endosc 1991;1(1):26–32. PMID: 1669373.
  21. Appel S, Krebs H, Fern D. Techniques for laparoscopic cholangiography and removal of common duct stones. Surg Endosc 1992;6(3):134–137. DOI: 10.1007/BF02309086.
  22. Vezakis A, Fragulidis G, Polydorou A. Endoscopic retrograde cholangiopancreatography-related perforations: diagnosis and management. World J Gastrointest Endosc 2015;7(14):1135–1141. DOI: 10.4253/wjge.v7.i14.1135.
  23. Fanning NF, Horgan PG, Keane FBV. Evolving management of common bile duct stones in the laparoscopic era. J R Coll Surg Edinb 1997;42(6):389–394. PMID: 9448394.
  24. Heili MJ, Wintz NK, Fowler DL. Choledocholithiasis: endoscopic versus laparoscopic management. Am Surg 1999;65(2):135–138.
  25. Baloyiannis I, Tzovaras G. Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis. World J Gastrointest Endosc 2015;7(7):714–719. DOI: 10.4253/wjge.v7.i7.714.
  26. Hamouda AH, Goh W, Mahmud S, et al. Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery. Surg Endosc 2007;21(6):955–959. DOI: 10.1007/s00464-006-9127-2.
  27. Mourad FH, Khalifeh M, Khoury G, et al. Common bile duct obstruction secondary to a balloon separated from a Fogarty vascular embolectomy catheter during laparoscopic cholecystectomy. Surg Endosc 2000;14(5):500–501. DOI: 10.1007/s004640000128.
  28. Ahmed T, Alam MT, Ahmed SU, et al. Role of intraoperative flexible Choledochoscopy in calculous biliary tract disease. Mymensingh Med J 2012;21(3):462–468. PMID: 22828544.
  29. Darwin P, Goldberg E, Uradomo L. Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc 2010;71(1):99–104. DOI: 10.1016/j.gie.2009.08.015.
  30. Conrad C, Wakabayashi G, Asbun HJ, et al. IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci 2017;24(11):603–615. DOI: 10.1002/jhbp.491.
  31. Koch M, Garden OJ, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011;149(5):680–688. DOI: 10.1016/j.surg.2010.12.002.
  32. Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.). Diagnosis and treatment of common bile duct stones (CBDS). Results of a consensus development conference. Surg Endosc 1998;12(6):856–864. PMID: 9602006.
  33. Bray MS, Borgert AJ, Folkers ME, et al. Outcome and management of endoscopic retrograde cholangiopancreatography perforations: a community perspective. Am J Surg 2017;214(1):69–73. DOI: 10.1016/j.amjsurg.2017.01.034.
  34. Koc B, Karahan S, Adas G, et al. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 2013;206(4):457–463. DOI: 10.1016/j.amjsurg.2013.02.004.
  35. Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 2010;145(1):28–33. DOI: 10.1001/archsurg.2009.226.
  36. Bansal VK, Misra MC, Rajan K, et al. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 2014;28(3):875–885. DOI: 10.1007/s00464-013-3237-4.
  37. Del Pozo D, Tabernero S, Poves E, et al. Usefulness of endoscopic ultrasonography in the clinical suspicion of biliary disease. Rev Esp Enferm Dig 2011;103(7):345–348. DOI: 10.4321/s1130-01082011000700002.
  38. Pérez-Cuadrado E. El papel de la ecoendoscopia en la vía biliar. La gran amiga de la ERCP. Rev Esp Enferm Dig 2011;103(7):341–344. DOI: 10.4321/S1130-01082011000700001.
  39. Podda M, Polignano1 FM, Luhmann A, et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surg Endosc 2016;30(3):845–861. DOI: 10.1007/s00464-015-4303-x.
  40. Phillips EH, Liberman M, Carroll BJ, et al. Bile duct stones in the laparoscopic era. Is preoperative sphincterotomy necessary? Arch Surg 1995;130(8):880–886. DOI: 10.1001/archsurg.1995.01430080082013.
  41. Hoyuela C, Cugat E, Bretcha P, et al. Must CPRE be routinely performed if choledocholithiasis is suspected? Dis Surg 1999;16(5):411–414. DOI: 10.1159/000018757.
  42. Sgourakis G, Lanitis S, Karaliotas Ch, Gockel I, Kaths M, Karaliotas C. Laparoscopic versus endoscopic primary management of choledocholithiasis. A retrospective case-control study. Chirurg. 2012 Oct;83(10):897-903. DOI: 10.1007/s00104-012-2279-9. https://pubmed.ncbi.nlm.nih.gov/22476872/.
  43. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335(13): 909–918. DOI: 10.1056/NEJM199609263351301.
  44. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998;48(1):1–10. DOI: 10.1016/s0016-5107(98)70121-x.
  45. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001;96(2):417–423. DOI: 10.1111/j.1572-0241.2001.03594.x.
  46. Rituerto C. Complications in biliary surgery. Cir Esp 2001;69:261–268.
  47. Scollay JM, Mullen R, McPhillips G, et al. Mortality associated with the treatment of gallstone disease: a 10 year contemporani national experience. World J Surg 2011;35:643–647. DOI: https://doi.org/10.1007/s00268-010-0908-3\t_blank 10.1007/s00268-010-0908-3.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.