Open Common Bile Duct Research Articles

“IV plasty” a novel technique: Cystic duct flap closure following common bile duct exploration in children

Choledocholithiasis is increasingly seen in children; attributable to ever increasing diagnostic ultrasound availability and to the advances in medical care, including parenteral nutrition for children who have survived neonatal short bowel syndrome. Endoscopic expertise for managing paediatric choledocholithiasis is often unavailable or the procedure unsuccessful. Many of these children have multiple comorbidities and may have had previous laparotomies. Open Common Bile Duct (CBD) exploration becomes necessary in a large percentage of such children. The size and anatomy of the biliary tree often precludes a trans -cystic approach to CBD exploration. For this reason, frequently a choledochotomy is required. To avoid CBD stricture, insertion of a T-tube or stent is recommended, but these are associated with complications and appropriate small size devices are often unavailable. We present a technique for closure of the CBD after a choledochotomy that prevents the duct from narrowing, without the use of stents. This technique can also be employed for other tubular structures. • Choledocholithiasis is increasingly seen in children. • Endoscopic management of paediatric choledocholithiasis is often unavailable/unsuccessful. • Common bile duct exploration and choledochotomy predisposes to ductal stricture. • Closure of the choledochotomy using a flap of cystic duct can prevent strictures.

Efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis

Objective To study the efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis. Methods From March 2014 to March 2017, 150 cases of complicated hepatolithiasis who were treated in Heji Hospital Affiliated to Changzhi Medical College were selected.The patients were divided into observation group and control group according to random number table, with 75 cases in each group.The control group was treated with conventional open abdominal common bile duct exploration, and the observation group was treated by laparoscopic choledochal exploration.The levels of surgical indicators, the incidence of complications, the recurrence rate, the bilirubin level before operation and 1 month after operation, and the quality of life before operation and 6 months after operation were compared between the two groups. Results The operative time, intraoperative blood loss, gastrointestinal recovery time and hospitalization time in the observation group were (154.23±20.47)min, (59.12±8.92)mL, (19.65±3.48)h, (11.48±2.48)d, respectively, which were significantly lower than those in the control group [(217.59±30.59)min, (87.24±10.17)mL, (27.87±6.12)h, (16.51±4.28)d] (t=14.908, 18.002, 10.112, 8.806, all P<0.05). The levels of total bilirubin, direct bilirubin and indirect bilirubin in the observation group at 1 month after operation were (14.38±3.69)μmol/L, (3.39±1.17)μmol/L, (11.45±3.02)μmol/L, which were significantly lower than those in the control group [(28.43±4.31)μmol/L, (6.31±2.08)μmol/L, (21.05±4.87)μmol/L] (t=21.445, 10.596, 14.508, all P<0.05). The incidence rate of complications and recurrence rate of the observation group at 6 months after operation were 2.67% and 0.00%, respectively, which were lower than 14.67% and 10.67% of the control group (χ2=6.822, 8.451, all P<0.05). The scores of social activities, energy, physical activity and sleep mood in the observation group at 6 months after operation were (4.72±0.85)points, (13.25±1.21)points, (3.81±0.51)points, (6.52±2.44)points, respectively, which were higher than those in the control group [(2.65±0.61)points, (8.09±0.68)points, (1.95±0.52)points, (3.98±2.38)points] (t=10.513, 11.605, 12.604, 6.454, all P<0.05). Conclusion Laparoscopic choledochal exploration is effective in the treatment of complicated hepatolithiasis, and it can improve the level of bilirubin and improve the quality of life, the safety is good. Key words: Cholecystolithiasis; Laparoscopy; Bilirubin; Comparative Effectiveness Research

Chronic Pancreatitis: Laser Technologies for Double Balloon Enteroscopy of Pancreatojejunostomy Complications and Reducing the Peripheral Ductal Hypertension

Introduction: Drainage procedures are conventional modifications of surgical treatment for chronic pancreatitis (CP). Nevertheless, the relapse of chronic abdominal pain after the surgery occurs in more than 50% of cases. Aim: To explain the pathogenesis of intractable abdominal pain following the traditional surgery of CP and to propose new laser and double balloon enteroscopy (DBE) technologies for its relief. Materials and methods: Pancreatojejunoanastomosis (PJA) lumen was examined using the videoenteroscope EN-450P5/20 (Fujifilm group, Fujinon Co, Tokio, Japan) for the first time in the world. All 20 patients had had CP and underwent an elective surgery earlier. During 2010-2014, 198 resections were performed, with 159 (80,3%) being laser drainage procedures. Results: DBE revealed strictures of PJA and open common bile duct, residual pancreatoliths in PJA lumen, and PJA leakage. After DBE laser lithotripsy of pancreatoliths in tributary ducts, a free outflow of pancreatic juice from the lumen was obtained. DBE findings were supported by the morphological study of excised pancreatic specimen, CT-scans before the surgery and the staining of PJA lumen. All these data suggest that 17,7% of CP patients along with magistral ductal hypertension had peripheral ductal hypertension (PDH), which seems to be a new cause of severe abdominalgia. The latter arises when pancreatoliths block the orifices of tributary ducts. For reducing the PDH, we have developed a new surgical procedure named «laser cylindric wirsungectomy» (n=26) and proposed our own classification of pancreatic duct stones. Conclusions: DBE has great opportunities for the diagnosis of complications and their mini-invasive treatment after pancreatojejunostomy (PJ). Laser technologies are considered to be a new approach to the effective open and mini-invasive surgical treatment of CP.

Choledochoscopy as a diagnostic and therapeutic tool for common bile duct stones

Aim-Background The aim is to present the results of a retrospective study comparing a) choledochoscopy in open and laparoscopic Common Bile Duct Exploration (CBDE) regarding the clearance of Common Bile Duct (CBD) from stones, b) open CBDE with and without choledochoscopy, and c) transcystic vs. transductal laparoscopic choledochoscopy.

Assessment and treatment of choledocholithiasis when endoscopic sphincterotomy is not successful.

Choledocholithiasis exists in approximately 15% of patients with gallstones and is present in 3%-10% of those undergoing cholecystectomy. In this study, we retrospectively analyzed the outcome patients with choledocholithiasis that were managed by open common bile duct (CBD) exploration according to our center's protocol. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for CBD stone clearance. If ERCP and sphincterotomy were not successful, open surgical exploration of CBD was performed with T-tube insertion without routine intraoperative cholangiography (IOC). We studied 1462 patients with choledocholithiasis. ERCP was successful in in 1276 (87.2%) patients. A total of 186 (12.8%) underwent surgery. Of these, 82 (45.2%) had CBD exploration and T-tube insertion without IOC. Choledochoduodenostomy was performed in 82 (44.1%) patients and choledochojejunostomy was performed in 20 (10.8%). Retained stones were found only in 4 cases which were treated by ERCP. ERCP is successful in most cases with choledocholithiasis. If ERCP fails, open exploration of CBD and T-tube insertion, or biliary-enteric anastomosis are acceptable ways for CBD drainage. The rate of retained stone is not more than expected, thus elective IOC is more acceptable than routine IOC. Routine IOC is time-consuming and particularly difficult in elderly patients and emergency conditions.

Radiological Reasoning: Postoperative Hemorrhage After Open Cholecystectomy and Common Bile Duct Exploration

OBJECTIVE The diagnosis and management of postoperative symptomatic intraperitoneal hemorrhage and hemobilia that occurred after an open cholecystectomy and common bile duct exploration for symptomatic choledocholithiasis are discussed. An active bleeding source from the cystic artery stump was identified by angiography. Minimally invasive therapeutic options, including arterial embolization, are addressed. CONCLUSION Postoperative intraperitoneal hemorrhage and hemobilia of a cystic artery stump can be accurately diagnosed and safely treated with emergent angiography and embolization.

Congenital Duplication of the Gallbladder

Duplication of the gallbladder is a rare congenital anomaly of the biliary system. In this article, two cases of gallbladder duplication are presented. The first case is a patient with double gallbladder and concomitant choledocholithiasis. The probable diagnosis of double gallbladder was made preoperatively by computed tomography. The patient underwent a successful open cholecystectomy and common bile duct exploration. In the second case, two cystic formations in the place of gallbladder are demonstrated with ultrasound scan in a woman with acute cholecystitis. At surgery, two gallbladders were found. A brief review of epidemiology and anatomy of double gallbladder is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.