PERCUTANEOUS PAPILLARY BALLON DILATION AND LAPAROSCOPIC

Abstract

Twelve cases of bile duct and gallbladder stones were subjected to a study of clinically evaluating the usefulness for percutaneous papillary balloon dilation (PPBD) with laparoscopic cholecystectomy (LC). In conducting the PPBD, a gastointestinal ballon for dilation was inserted throught the percutaneous transhepatic bile duct (PTBD) route to dilate the papilla; and after the papilla was dilated, bile duct stones were pushed out to the duodenum by using a ballon catheter for angiography. LC was used in due form. The maximum horizontal diameter of the bile duct stones ranged from 7mm to 15mm (11 ± 3mm), and there were one to 25 stones. Ten patients had the stones in the common hepatic duct-common bile duct, and two patients in the left hepatic duct-common bile duct. Removal of stones were possible in all cases, but two patients who had stones with horizontal diameter of over 13mm necessitated lithotripsy with electric hydrostatic percussion waves (a success rate: 100%). It took 146 ± 26 minutes for LC operation. Hospital stay after LC was 9 ± 3 days. Indwelling time of PTBD was 23 ± 6 days and total mean hospital stay was 26 ± 3 days. We think that PPBD can be used for cases of multiple bile duct stones, those of huge stones, and those in which the stones are escaped during operation. Further, the associated use of PPBD with LC may contribute to an increase in candidates who are omitted from laparotomy.