Laparoscopic Common Bile Duct Stone Research Articles

Intraoperative transcystic laparoscopic common bile duct stone clearance with SpyGlass™ discover during emergency and elective cholecystectomy: a single-center case series

Background and study aimThe development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective.Patients and methodsThe investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023.ResultsA complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred.ConclusionThis procedure has proven to be feasible, safe, and effective.

Laparoscopic transcystic common bile duct exploration in patients with a nondilated common bile duct.

Laparoscopic transcystic common bile duct exploration (LTCBDE) is the minimally traumatic surgical method for the treatment of choledocholithiasis secondary to cholecystolithiasis with dilated common bile duct (CBD). However, no report exists concerning LTCBDE in patients with nondilated CBD. The purpose of this study was thus to explore the safety, efficacy, and feasibility of LTCBDE in patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD. We retrospectively analyzed 47 patients with choledocholithiasis secondary to cholecystolithiasis who were treated with LTCBDE at the Second Affiliated Hospital of Nanchang University from January 2017 to August 2021 (all the patients had undergone endoscopic retrograde cholangio-pancreatography treatment, but this failed due to various reasons). Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction, and surgical outcomes were collected and reviewed. Each patient was followed up for more than 3 months. There were 47 patients in this study, including 21 females and 26 males, with their ages ranging from 15 to 82 years (51±15 years). All patients were treated with surgery, and the CBD stones were removed successfully. Among these patients, 45 underwent LTCBDE for the removal of stones in the CBD, with failure occurring in 2 patients who then accepted laparoscopic common bile duct stone removal (LCBDE) + T tube drainage. The diameter of the cystic duct was 0.30-0.73 cm (0.60±0.07 cm), the diameter of the CBD was 0.60-0.80 cm (0.73±0.05 cm), the operation time was 75-220 minutes (159±33 minutes), and the postoperative hospital stay was 2-13 days (6±2 days). None of the patients experience any serious postoperative complications, and all were discharged safely. During the follow-up, no postoperative biliary stenosis, bile leakage, or other complications occurred. LTCBDE is feasible to treat patients with choledocholithiasis secondary to cholecystolithiasis with nondilatation of the CBD. This choice of treatment plan reduces the length of hospital stay and the occurrence of postoperative complications. However, it is recommended that this be attempted on the basis of the experience of LTCBDE with dilated CBD.

The clinical application of laparoscopic common bile duct stone removal

Cholecystolithiasis with choledocholithiasis (CCL) is a common disease. The removal of common bile stone is a challenge for the surgery. This paper discussed the clinical application of three stone removal techniques including direct stone removal, irrigation and stone extraction by basket under cholangioscopy in order to take the stones effectively and safely, shorten the procedure time, avoid the injuries of common bile duct wall caused by the repetition of a single method such as biliary endoscopic stone extraction, reduce the difficulty of taking stone and enhance recovery of patients. Key words: Laparoscopy; Common bile duct stone; Cholecystolithiasis; Lithotomy forceps; Irrigation; Biliary endoscopic stone extraction

Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step?

Because choledochoscopy often is a challenging maneuver, it would be advantageous to define the real utility of its use. This study aimed to compare blind exploration of the common bile duct (CBD) with choledochoscopy-assisted CBD stone removal in terms of patient outcome and complication rate. Two groups of patients were prospectively evaluated in a 4-year period. The study participants were 36 men and 27 women randomized to group A (n = 32) for a blind basket procedure or group B (n = 31) for a choledochoscopy-assisted procedure as the first step of laparoscopic CBD stone removal. Patients with preoperatively suspected CBD stones (n = 51) and those with unsuspected stones (n = 12) were included. The two groups did not differ significantly in terms of anagraphics, American Society of Anesthesiology (ASA) score, or previous surgery. All the procedures were performed by surgeons skilled in this surgical field. Choledochoscopy, when used, was always performed with the instrument connected to a camera monitor that had a wide vision, whether in a single-monitor, in a picture-in-picture manner, or with the use of an additional monitor. From March 2004 to April 2008, 63 patients undergoing CBD exploration for stone removal were enrolled in the study. Five of these patients had undergone previous endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (ES). The mean operative time was 107 min for group A and 122 min for group B. The mean hospital stay was 3 days for group A and 3.6 days for group B. Clearance of CBD stones was achieved laparoscopically in 62 cases. One patient required open combined transduodenal papilloplasty and transcholedochotomy. In seven cases, blind basket exploration was unable to remove the stones according to the cholangiogram, so choledochoscopy was required. Six patients underwent a transversal coledocothomy for stone removal. A Kehr T-tube was placed in four of these patients. In four group A cases, the papilla was inadvertently passed during the procedure. In six group A cases, including the four aforementioned cases, a high level of amylases was found on postoperative day 1. At this writing, no late complications or stone recurrences have been observed in either group. The laparoscopic basket blind technique and choledochoscopy are safe and effective for CBD stone removal. However, the latter seems to be better in terms of a higher stone removal rate and fewer minor complications despite its longer operation time. In the authors' opinion, it may be preferable to reserve ERCP for very high-risk patients, taking into account that in addition to the related complications, it results in an approximate 10% rate of recurrent or persistent stones.

Laparoscopic common bile duct stone clearance with flexible choledochoscopy

Laparoscopic common bile duct exploration (LCBDE) is as safe and efficient as endoscopic retrograde cholangiopancreatography (ERCP) in achieving bile duct clearance from stones. No clear guidelines are available on LCBDE with respect to indications for trans-cystic approach versus choledochotomy, or regarding when to use either flexible choledochoscopy (FCD) or intraoperative cholangiography (IOC) guidance. From January 2001 until November 2006, 113 consecutive patients with common bile duct stones (CBDS) and gallbladder in situ were enrolled in a prospective non-randomized study to undergo laparoscopic cholecystectomy with LCBDE on an intention-to-treat basis. Twenty-three patients were aged 80 years or older with severe comorbidity. Preoperative ERCP with attempted stone clearance was performed in 24 patients. Laparoscopic common bile duct exploration was attempted for CBDS in the presence of acute cholecystitis in 24 patients. Laparoscopic common bile duct exploration was performed via the trans-cystic approach in 83 patients and via choledochotomy in 30 patients. Flexible choledochoscopy was used in 79 patients and IOC guidance in 34 patients. No mortality occurred. Postoperative complications were encountered in nine patients. Laparoscopic stone clearance of the bile duct was successful in 91.8% of the patients. Median length of hospital stay (LOS) was two days (range, 0 to 24 days) after trans-cystic LCBDE and six days (range, 2 to 34 days) after stone clearance via choledochotomy (p < 0.0001). Choledochotomy was performed for CBDS measuring an average of 11.5 mm (range, 5 to 30 mm) in diameter while trans-cystic LCBDE was successful for stones measuring an average of 5 mm (range, 2 to 14 mm) (p < 0.0001). Mean duration of surgery was 75 minutes (range, 30 to 180 minutes) when FCD was used, and 107 minutes (range, 45 to 240 minutes) in patients undergoing LCBDE under IOC guidance (p < 0.0001). Laparoscopic cholecystectomy and LCBDE with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. A trans-cystic approach is feasible in most patients, whereas choledochotomy should be restricted to large bile duct stones that cannot be extracted through the cystic duct. The use of flexible choledochoscopy is preferable to IOC guidance.

Management of Choledocholithiasis During Pregnancy by Magnetic Resonance Cholangiography and Laparoscopic Common Bile Duct Stone Extraction

Management of Choledocholithiasis During Pregnancy by Magnetic Resonance Cholangiography and Laparoscopic Common Bile Duct Stone Extraction

Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction.

Management of common bile duct (CBD) stones during pregnancy is a difficult problem. The authors reported the case of a patient who was 22 weeks' pregnant who had a symptomatic CBD stone successfully treated by the association of magnetic resonance cholangiography and laparoscopic CBD stone removal. The patient delivered a healthy baby boy at 39 weeks. Magnetic resonance cholangiography and laparoscopic CBD exploration is a viable option in the management of CBD stones in pregnant patients that carries a low risk for the fetus while preserving the advantages of minimally invasive surgery for the mother.

Costs of endoscopic vs. laparoscopic common bile duct stone extraction

Costs of endoscopic vs. laparoscopic common bile duct stone extraction

Laparoscopic transcystic duct balloon dilatation of the sphincter of Oddi.

Balloon dilatation of the sphincter of Oddi has been performed via a laparoscopic transcystic duct technique. Small common duct stones and stone debris have been successfully lavaged into the duodenum in 17 of 20 cases (85%) by this method. Postoperative hyperamylasemia was noted in four patients. Mild clinical pancreatitis was observed in three patients (15%). Further evaluation of this technique as an adjunct to laparoscopic common bile duct stone extraction is warranted.