Secondary Common Bile Duct Stones Research Articles

Comparison of Primary Suture and T-Tube Drainage After Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy in the Treatment of Secondary Common Bile Duct Stones: A Single-Center Retrospective Analysis.

Objective: To compare the safety and feasibility of T-tube drainage and primary suture after laparoscopy combined with choledochoscopy in the treatment of secondary choledocholithiasis. Methods: The clinical data of patients who underwent laparoscopic choledochoscopy combined with choledochoscopic common bile duct exploration (LCBDE) for secondary choledocholithiasis from June 2015 to June 2020 were analyzed retrospectively. According to the different treatment method of common bile duct (CBD) incision, the patients were divided into a T-tube drainage group and a primary suture group. The preoperative clinical characteristics, results of preoperative liver function tests (LFTs), LFTs on the first day after the operation and the fourth day after the operation, operation time, intraoperative bleeding, postoperative complications, and times of postoperative hospital stay were compared between the two groups. Results: There was no significant difference in preoperative clinical data, preoperative LFTs, and postoperative complications between the two groups (P > .05). However, primary suture demonstrated significant advantages (P < .05) in terms of the operation time, intraoperative blood loss, postoperative hospital stay, and other related factors. Bilirubin levels on the first day after the operation and the fourth day after the operation between the two groups suggested that T-tube drainage reduces bilirubin in the short term, but that long-term bilirubin draining is similar between the two strategies. Univariate and multivariate analyses showed that choledochal diameter less than 8 mm was an independent risk factor for bile leakage. Conclusions: Laparoscopy combined with intraoperative choledochoscopic CBD exploration is superior to T-tube drainage in terms of the operation time, intraoperative blood loss, and postoperative hospital stay. The ability of reducing bilirubin by traditional T-tube drainage is indeed better than that of primary suture in the early stage after operation, but there is no difference in long-term outcome between the two groups. Choledochal diameter ≤8 mm was an independent risk factor for bile leakage. To summarize, LCBDEs primary suture for secondary choledocholithiasis is safe and feasible.

Ursodeoxycholic acid combined with percutaneous transhepatic balloon dilation for management of gallstones after elimination of common bile duct stones.

AIMTo evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct (CBD) stones.METHODSFrom April 2014 to May 2016, 15 consecutive patients (6 men and 9 women) aged 45-86 (mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder.RESULTSAll patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain (n = 1), abdominal distension (n = 1), and fever (n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred.CONCLUSIONFor patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.

Single-operator cholangioscopy for the treatment of concomitant gallbladder stones and secondary common bile duct stones.

This study aims to assess the clinical validity and safety of single-operator cholangioscopy system (SOCS) for the treatment of concomitant gallbladder stones and secondary common bile duct (CBD) stones. This retrospective study included 10 consecutive patients who had small-sized stones (<1cm) in both the gallbladder and CBD; the patients underwent SOCS treatment from June 2016 to December 2016. The clinical validity of this minimally invasive surgery was determined by the operation success rate, stone removal rate, postoperative hospital stay, hospitalization cost, and contrast images before and after the operation. The clinical safety was evaluated by perioperative complications and outcomes, gallbladder stone recurrence, and gallbladder contractility function. Both the technique success rate and the stone removal rate when using SOCS was 100%. There were no serious complications that occurred during the operation; three patients developed acute cholecystitis, and four patients underwent hyperamylasemia after the surgery. The average postoperative hospital stay was 5.8±1.32days, and the average hospitalization cost was 7466±566.1 dollars. In the follow-up period, which ranged from 3 to 8months, there was no stone residuals or recurrences in the gallbladder and CBD, and no patient showed a recurrence of biliary colic. In addition, the gallbladder contractility function was proven to be normal within 3 to 6months after the operation. SOCS could successfully manage concomitant gallbladder stones and secondary CBD stones and precisely protect normal biliary function.

Diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones

Objective To investigate the diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones. Methods The retrospective cohort study was conducted. The clinical data of 460 patients with gallbladder stones who were admitted to the Affiliated Hospital of Zunyi Medical College from June 2012 to June 2016 were collected. Of 460 patients, 106 combined with asymptomatic secondary common bile duct stones and 354 with gallbladder stones were allocated into the common bile duct stone group and gallbladder stone group, respectively. The serum liver function test was applied to the 2 groups, including alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBil), direct bilirubin (DBil), glutamyltransferase (GGT) and alkaline phosphatase (ALP). The receiver operating characteristic (ROC) curve was built using significant statistical indicators, and correspondent cut-off value, sensitivity and specificity were calculated according to ROC curve. Observation indicators: (1) comparison of serum liver function indicators (ALT, AST, TBil, DBil, GGT, ALP) between the 2 groups; (2) analysis result of ROC curve. Measurement data with normal distribution was represented as ±s. The comparison between groups was evaluated with the independent-sample t test. The comparison of count data were analyzed using the chi-square test. The ROC curve analysis was done for significant statistical indicators. Results (1) Comparison of serum liver function indicators between the 2 groups, the levels of ALT, AST, TBil and DBil were (32±8)U/L, (35±8)U/L, (12.8±2.5)μmol/L, (2.6±0.4)μmol/L in the common bile duct stone group and (30±7)U/L, (32±7)U/L, (12.2±2.4)μmol/L, (2.5±0.4)μmol/L in the gallbladder stone group, respectively, with no statistically significant difference (t=0.891, 0.786, 0.924, 1.026, P>0.05). The levels of GGT and ALP were (162±43)U/L and (145±37)U/L in the common bile duct stone group and (36±10)U/L and (128±23)U/L in the gallbladder stone group, respectively, with significantly statistical differences (t=20.859, 2.483, P<0.05). (2) Result of ROC curve showed that areas under the curve of GGT and ALP were respectively 0.963 [95% confidence interval (CI): 0.938-0.988] and 0.621 (95%CI: 0.561-0.684). The correspondent cut-off value of diagnostic accuracy, sensitivity and specificity of GGT and ALP were 92.5 U/L and 139.5 U/L, 91.6% and 50.7%, 95.7% and 76.5%, respectively. Conclusion The abnormally elevated levels of serum GGT have major diagnostic value for patients with gallbladder stones combined with asymptomatic secondary common bile duct stones, with an advantage of convenient and fast operation, and it is worth to be applied and popularized. Key words: Cholelithiasis; Gallbladder stone; Common bile duct stone, secondary; γ-glutamyltransferase; Diagnosis

Risk factors for gallbladder contractility after cholecystolithotomy in elderly high-risk surgical patients.

ObjectiveCholecystolithiasis is a common disease in the elderly patient. The routine therapy is open or laparoscopic cholecystectomy. In the previous study, we designed a minimally invasive cholecystolithotomy based on percutaneous cholecystostomy combined with a choledochoscope (PCCLC) under local anesthesia.MethodsTo investigate the effect of PCCLC on the gallbladder contractility function, PCCLC and laparoscope combined with a choledochoscope were compared in this study.ResultsThe preoperational age and American Society of Anesthesiologists (ASA) scores, as well as postoperational lithotrity rate and common biliary duct stone rate in the PCCLC group, were significantly higher than the choledochoscope group. However, the pre- and postoperational gallbladder ejection fraction was not significantly different. Univariable and multivariable logistic regression analyses indicated that the preoperational thickness of gallbladder wall (odds ratio [OR]: 0.540; 95% confidence interval [CI]: 0.317–0.920; P=0.023) and lithotrity (OR: 0.150; 95% CI: 0.023–0.965; P=0.046) were risk factors for postoperational gallbladder ejection fraction. The area under receiver operating characteristics curve was 0.714 (P=0.016; 95% CI: 0.553–0.854).ConclusionPCCLC strategy should be carried out cautiously. First, restricted by the diameter of the drainage tube, the PCCLC should be used only for small gallstones in high-risk surgical patients. Second, the usage of lithotrity should be strictly limited to avoid undermining the gallbladder contractility and increasing the risk of secondary common bile duct stones.

Giant Staghorn Common Bile Duct Calculus (A Case Report)

Giant staghorn common bile duct (CBD) calculi are usually uncommon but can be found in patients with oriental cholangiohepatitis. The size of stone can vary from few millimetres to several centimetres. These are usually pigment stones and patients can present with pain, jaundice and fever or some times Reynold's pentad. Primary bile duct stones form within the bile ducts and usually are of brown pigment variety containing higher proportion of bilirubin as compared to cholesterol. Bile infection appears to be the initial event leading to stone formation. The secondary CBD stones arise from gall bladder or intra and extrahepatic ducts. They are mostly cholesterol stones. We are presenting a case in which we removed a giant staghorn calculus from the CBD measuring 11.5 × 4 cm and weighing about 100 grams.

A double gallbladder with a common bile duct stone treated by laparoscopy accompanied by choledochoscopy via the cystic duct: A case report.

A double gallbladder is a rare congenital malformation. The present study describes a case of double gallbladder with secondary common bile duct stones. By way of laparoscopic choledochoscopy, the exploration and removal of a common bile duct stone was performed through the cystic duct. The process involved a primary suture of the cystic duct and was performed without using a T-tube, and completed a surgical removal of the gallbladder. The present case was successfully treated by laparoscopic surgery. From a review of previous studies published in the English language, this study, to the best of our knowledge, is the first report of such a case. Therefore, laparoscopic dissection is safe for the removal of a double gallbladder and for exploration of the common duct by choledochoscopy.

Secondary Common Bile Duct Stones in Congenital Right Side Diaphragmatic Hernia: A Case Report

Congenital diaphragmatic hernia (CDH), which usually induces pulmonary symptoms, is more diagnosed in infant than in adult. Right-side hernia is rarer because the right pleuroperitoneal canal closes earlier and the liver buttresses the right diaphragm. We report an unusual case of a right-sided congenital diaphragmatic hernia complicating with secondary common bile duct stones in a 43-year-old man.

THE EFFECT OF URSODEOXYCHOLIC ACID AS A CONSERVATIVE TREATMENT OF SECONDARY COMMON BILE DUCT STONES IN PREPARATION FOR LAPAROSCOPICAL CHOLECYSTECTOMY

Calculus cholecystitis with secondary bile duct stones is a surgical problem that solved by many surgical/conservative options. In our study we use oral Ursodeoxycholic acid as a medical dissolution therapy for secondary common bile duct stones in preparation for cholecystectomy. The study aimed to see the effects of ursodeoxycholic acid on biliary stone dissolution in our locality. A prospective study on twenty one patients presented with calculus cholecystitis and CBD stones from January 2010 to January 2011 involved in this study, they received oral Ursodeoxycholic acid (ursogall, UDCA) in a dose of 300 mg twice daily p.o over period of four to six weeks & some of them repeat course of treatment. During the period of observation, seventeen patients respond to medical treatment showed decrease or absence of jaundice and four patients show no response. It is concluded that: This study illustrate that we can use bile acids as medical dissolution treatment in some indicated patients with CBD stones, there is a chance of conservative treatment to be a way of treating patients with obstructive jaundice due to common bile duct stones, although the number of patient is small owing to the natural occurrence of such cases all over the world and we are lacking the standard facilities of identical research equipment and the comparative differentiation between diseased patients and control cases ; our results need further research with big number of patients and more elements of investigations.

A clinical comparison of two strategies for minimal invasive treatment of secondary common bile duct stone

To compare the clinical efficiency of two strategy in the treatment of secondary common bile duct stones: laparoscopic cholecystectomy with transcytotic common bile duct exploration (LC + LTCBDE), or laparoscopic cholecystectomy after endoscopic sphincterotomy (EST + LC). According to the screening standard, 88 patients with secondary bile duct stones (43 cases in LC + LTCBDE group, 45 cases in EST + LC group) who were treated from June 2005 to November 2007 were analyzed retrospectively. The achievement ratio, complications, average hospital stay and cost between two groups were compared. And all patients were followed up. There were no significant differences on achievement ratio and complications between two groups (P > 0.05). The LC + LTCBDE group has significantly shorter hospital stay and lower cost (P < 0.05). There were no recurrence in 1 year. LTCBDE is a promising strategy which has more advantages in the minimal invasive treatment of secondary common bile duct stones.

Current management of common bile duct stones: Is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure?

Background. Although laparoscopic cholecystectomy (LC) and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) have revolutionized the management of secondary common bile duct (CBD) stones, the use of these modalities as a single-stage procedure remains controversial. The aim of this study is to determine whether LC and intraoperative ERCP as a single procedure has any advantages to LC and either preoperative or postoperative therapeutic ERCP performed in 2 stages. Methods. A retrospective 5-year review involved all patients undergoing both LC and ERCP for management of CBD stones from January 1997 to December 2001. Patients were categorized into 3 groups: (1) preoperative ERCP, followed by LC (ERCP then LC); (2) LC, followed by postoperative ERCP (LC then ERCP); and (3) LC with intraoperative ERCP as a single procedure (LC/ERCP). Results. Sixty-seven patients were treated for secondary CBD stones. Forty-three patients underwent ERCP then LC, 10 underwent LC then ERCP, and 14 patients underwent LC/ERCP. There were no differences among the groups in terms of patient demographics or overall complication rates. CBD access and stone clearance was achieved in all 67 (100%) patients, with 1 mild ERCP-related complication in the ERCP-then-LC group. Overall complication rates, hospital length of stay, and total hospital charges were not statistically different among the 3 groups. Conclusion. Single-stage LC/ERCP provides efficacious therapy for CBD stones and may be beneficial in select patients who may not tolerate a second anesthetic procedure. (Surgery 2002;132:729-37.)

4639 The risk factors for the recurrence of primary common bile duct stones after endoscopic biliary sphincterotomy.

Background: Endoscopic biliary sphincterotomy (EST) is a well-established procedure for removing common bile duct (CBD) stones. CBD stones can be clssified into primary and secondary stones. However, few data are available on the recurrence of primary and secondary CBD stones after EST, respectively. We therefore studied risk factors prospectively for the recurrence of primary CBD stones after EST. METHODS: Between 1991 and 1997, 47 patients underwent endoscopic sphincterotomy for primary CBD stones. They were included in primary CBD stones which had the following criteria; 1) previous cholecystectomy without surgical CBD exploration 2) the detection of CBD stones at least two years after initial cholecystectomy. The results of 47 cases were analyzed prospectively and mean follow-up was 2.3 years. The recurrence of primary CBD stones was defined as the detection of stones at least 6 months after complete removal of stones. Results: The recurrence rate of primary CBD stones was 21% (10 of 47). The cumulative recurrence rate increased over time, and reached 60% at 4 years after EST. Two significant risk factors for the recurrence of primary CBD stones were identified in a multivariate analysis. first, patients with CBD stones ≥13 mm in post-stone removal state relapsed more frequently than those with CBD diameter