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Background: Choledocholithiasis is primarily managed by endoscopic retrograde cholangiopancreatography (ERCP) but in certain situation particularly large and impacted common duct stone, the procedure may not succeed and this small group of patients require either open or laparoscopic common bile duct exploration followed by T-tube insertion. Usually T-Tube cholangiogram is performed on 10th postoperative day and tube is removed on 12-14th day. Alternatively, primary closure of duct after post exploratory choledochoscopy to ensure duct clearance with or without biliary stent can be done.Methods: This study was performed on 25 patients of failed endoscopic extraction, subjected to open choledocholithotomy. Group A (n=7) had T-tube insertion whereas group B (n=18) had primary closure of duct after choledochotomy.Results: 19 patients had calculus cholecystitis whereas 6 patients had prior cholecystectomy and later developed choledocholithiasis. 52% patients had impacted stone and 40% had large stone as a cause of ERCP failure. Postoperative pyrexia, cholangitis, septicemia, sub-hepatic bilious drainage and postoperative hospital stay was higher in T-tube group as compared to primary closure group.Conclusions: Primary closure over the biliary stent after cholecystectomy and/or choledocholithotomy has less morbidity as compared to T-tube insertion and hence should be preferred choice in choledocholithiasis, provided stone free duct is ensured peroperative using choledochoscopy.
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Objective: To assess the outcome of primary closure ofCommon Bile Duct (CBD) after open and laparoscopiccholedocholithotomy.Method: This descriptive observational study was conducted ina private hospital in Chattogram, Bangladesh from February2016 to June 2019. All the patients who underwent open orlaparoscopic choledocholithotomy during the study period wereincluded. Ultrasonographic findings of CBD and its stone,wound infection, operation time, bile leak, biliary peritonitis,hospital stay all were observed.Results: A total of 35 patients were found from clinical recordshaving male to female ratio of 1:1.9. Most of the patients werein 41- 50 years age group. Mean operating time was 135minutes in laparoscopic type and 80 minutes in open type.Overall wound infections were in 5 patients (14.28%) and allwere in open group. Bile leak were in 4 patients (11.42%).Post-operative transient jaundice in 5 patients (14.20%). Biliaryperitonitis in 3 patients (8.57%).Retained single stone in one, pelvic abscess and abortion inone. Mean hospital stay were 5days in open type and 2 days inlaparoscopic type.Conclusion: Primary closure of common bile duct aftercholedocholithotomy is relatively safe and not associated withthat much of complications.
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Objective To explore the indication,technology and clinical significance of laparoscopic choledocholithotomy and primary suture in treatment of choledocholithiasis.Methods 78 patients with choledocholithiasis were divided into two groups receiving respectively laparoscopic choledocholithotomy and T-tube drainage treatment,and laparoscopic choledocholithotomy and primary suture after common bile duct exploration.The time of operation,postoperative hospital stay and complications were analyzed and compared.Results Bile leakage occurred in 2 cases in the primary suture group and 3 cases in the T-tube drainage group;No residual stones or biliary stricture was found in either groups.The time of operation,postoperative complications were not statistically different (P ＞ 0.05).The difference in postoperative hospital stay and GI function recovery time between the two groups was statistically significant (P ＜ 0.05).Conclusion In well selected cases,the primary suture of common bile duct after laparoscopic choledocholithotomy is feasible and safe.
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Objective This paper preliminarily research the clinical effect of 3D laparoscopy in the biliary tract surgery.Methods Thirty-eight patients clinical data of cholelithiasis who accepted laparoscopic cholecystectomy and laparoscopic choledocholithotomy T-tube drainage from January 2015 to June 2016 were retrospectively analyzed,which sixteen patients underwent three-dimensional laparoscopic surgery while twenty-two patients underwent two-dimensional laparoscopic surgery. The operation time, intraoperative blood loss, postoperative drainage,time of drainage, postoperative hospital stay, hospital costs and the incidence of complications were observed in two groups.Results There was a statistical significant (P 0.05) in postoperative drainage, time of drainage, postoperative hospital stay, hospital costs and the incidence of complications between the two groups. One patient of 2D group suffered residual stones and recovered by choledochoscopy through T tube sinus after two months, while no one suffered residual stones in 3D group. There was no recurrence of stones in both groups during the follow-up period which varied from two months to eighteen months.Conclusions 3D laparoscopy enables biliary tract surgery was more accurate and minimally invasive, it has a widely applicable prospect.
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Objective To evaluate the safety and effect of one-way barbs line (absorbable sutures v - locTM180) in primary suturing of laparoscopic choledocholithotomy. Methods From July 2014 to June 2015, clinical data of 86 cases performed primary suturing in laparoscopic choledocholithotomy by the same performer were retrospectively analyzed. The patients were divided into three groups, One-way barbs line continuous full-thickness suture group (A group), ordinary absorption line continuous full-thickness suture group (B group) and ordinary absorption line discontinuous full-thickness suture group (C group). The bile duct suture needed time, intraoperative blood loss, postoperative eating time, postoperative hospital stay and postoperative bile fistula were compared. Results All the 86 cases underwent successful operation without T tube, and none of them received alternative open operation. Compared with group B and C, time needed for bile duct suturing in A group have statistical significance. There was no significant difference in the intraoperative blood loss, postoperative eating time, postoperative hospital stay between the three groups (P > 0.05). The incidence of postoperative bile fistula in A group were none. The incidence of postoperative bile fistula in B group was 1 case, the incidence of postoperative bile fistula in C group was 2 cases.Conclusions The method of one-way barbs line continuous full-thickness suture were simple and secure in primary suturing of laparoscopic choledocholithotomy.
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Introduction: Choledocholithiasis is present in approximately 15-20% of patients with gallstone and laparoscopic common bile duct exploration has been effectively employed many cases currently. National Center for Health Development, Mongolian Ministry of Health, registered 23180 cases of bile duct diseases which were 3.4% of total diseases, 2.5% of total surgery, 12.2% of total gastrointestinal disease, 46.9% of total liver and biliary tract diseases between 2000 and 2006. Biliary tract diseases increased 2.4 times and bile duct surgery increased 5.2 times than 15 years ago in Mongolia. To compare open choledocholithotomy and laparoscopic choledocholithotomy for common bile duct stones. Materials and Methods: This study was carried out in Mongolian national second central hospital and Inner Mongolian first medical university hospital. The clinical data of the106 patients with common bile duct stones were analyzed between Арril 2015 and Арril 2016. Duration of operation, blood loss, postoperative complication, period of hospital stay and expenditure of treatment were compared in open choledocholithotomy and laparoscopic choledocholithotomy. All patients were placed on a “T” tube drainage. Results: In results of the duration of operation (p=0.001), blood loss (p=0.001) and period of hospital (p=0.01) were significantly lower in laparoscopic choledocholithotomy group Postoperative complications and gastrointestinal function recovery time were lower in laparoscopic group whereas expenditure of treatment were lower in open choledocholithotomy. Conclusion: In conclusion main advantages of laparoscopic choledocholithotomy were reduced duration of operation, blood loss, period of hospital stay and lower postoperative complications however costly.
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While Choledocholithiasis is concomitant with gallstones in approximately 9.2％ ～ 14.3％ of the patients,and its treatment methods are mainly by surgery,including:(1)Open cholecystectomy and open choledocholithotomy 、T-tube drainage (OC-OCHTD) ; (2) Endoscopic retrograde cholangiopancreatography (ERCP) and Endoscopic sphincterotomy (EST),and followed by Laparoscopic cholecystectomy (LC) second stage (ERCP/EST + LC) ; (3) Laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC +CBDE).These three methods all have their own characteristics.The last two methods are minimally invasive surgery treatment.Practice has proved that LCBDE and ERCP + EST + LC treatment methods are feasible and show certain advantages,compared with OC-OCHTD reflecting the development of minimally invasive surgery.Practice has proved that LCBDE and ERCP + EST + LC treatment methods are feasible and show certain advantages,compared with OCHTD reflecting the development of minimally invasive surgery.But the indications of operation are need to be summarized constantly in clinical practice,while operation skills are also need to be improved.At present,many reports of the two methods of minimally invasive treatment have been published because of the controversy,such as surgical indications,hospitalization expense,operation time,therapy danger,complications and the length of hospital stay.Both LCBDE and ERCP + EST + LC show some advantages and disadvantages compared with each other.On proper indications,LCBDE embodies the superiority of minimally invasive surgery technology as a one-stage operation,which is preferred for patients of choledocholithiasis with concomitant gallstones.For patients,no matter what kind of operation method,less invasion,lower risk and less complications is the key for best treatment choise.
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ObjectiveTo compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST, and had no severe complications)were treated electively at the Beijing Friendly Hospital and Beijing Jishuitan Hospital from 2002 to 2009. These patients were divided into two groups according to the treatment they received: open operation (n=62), or EST (n=115). There was no significant difference in sex, age, ASA class,symptoms before operation, and complications before operation between the 2 groups. The following data were compared: operation time, blood loss, size and number of stone, duration of postoperative ileus, duration of abdominal pain, incidence of postoperative complications, duration of hospitalization, cost of hospitalization and operation, and incidence of residual stones. ResultsFor the open operation group, the operation time was 50-300 min (M=110), the blood loss was 10-300 ml (M=60), the duration of post-operative ileus was 24-96 h(M=48), the duration of abdominal pain was 0-96 h(M=48), the duration of hospitalization was 8-70 d(M=21), the duration of hyperamylasemia after operation was 8.1％ and the cost for operation was 546-2498 yuan (M=1503. 2). For the EST group, the operation time was 10-120 min (M=25), the blood loss was 2-40 ml (M=10),the duration of post-operative ileus was 1-48 h (M=3), the duration of abdominal pain was 0-144 h (M-0), the period of hospitalization was 5-56 d (M=17), the duration of hyperamylasemia after operation was 40％ and the cost for operation was 2028-5728 yuan (M=2028). There were significant differences in every aspect between these 2 groups of patients. Conclusions EST has a significantly shorter operation time, less blood loss, shorter duration of postoperative ileus, shorter duration of abdominal pain, shorter duration of hospitalization. However, EST had a significantly higher incidence of hyperamylasemia after operation and the cost was higher than open operation.
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Objective To investigate the feasibility and safety of transumbilical laparoscopic single-port choledocholithotomy in the treatment of common bile duct stones. Methods The clinical data of four patients who underwent transumbilical laparoscopic single-port choledocholithotomy at Shengjing Hospital of China Medical University from January to June, 2010 were retrospectively analyzed. The operation method and postoperative effects were reviewed. Results All the operations were successfully carried out. The mean operation time was 100 minutes and the mean blood loss was 62. 5 ml. All patients were cured without the occurrence ofcomplications except for one patient who had a peritoneal infection and was cured after surgical drainage. Conclusion Transumbilical laparoscopic single-port choledocholithotomy is safe and feasible, but indications should be strictly followed.
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PURPOSE: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. METHODS: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981~1985; n=159), 2nd (1986~1990; n=100), 3rd (1991~1995; n=111), 4th (1996~2000; n=141), and 5th (2001~2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. RESULTS: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. CONCLUSION: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.
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Humans , Cholangiocarcinoma , Drainage , Factor IX , Follow-Up Studies , Hepatectomy , Lithotripsy , RecurrenceABSTRACT
Hepatolithiasis is characterized by its intractablity and frequent recurrence that requires multiple operative and non-operative interventions. To clarify the optimal treatment modalities and their effectiveness, a total of 648 patients with hepatolithiasis and who had treated at Seoul National University Hospital between January 1981 and December 2005 were analyzed according to the different time periods. Hepatectomy as a primary treatment of hepatolithiasis has gradually increased and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased. New treatment modalities such as percutaneous choledochoscopic stone removal (PTCS) and laparoscopic liver resection were instituted during the past decades. Over the last 25 years, both advances in the operative stone clearance rate and the success rate of postoperative lithotripsy have resulted in an improved final stone clearance rate, and this has been progressive from 79.0% in the first period to 91.3% in the fifth period. In the last 10 years, the final clearance rate of hepatectomy, choledocholithotomy, drainage procedures and PTCS was 97.1%, 82.0%, 78.8% and 85.7%, respectively, and the rate of performing repeated hepatectomy, choledocholithotomy, drainage procedures and PTCS was 11.2%, 26.2%, 9.1% and 28.6% respectively. Hepatolithiasisassociated cholangiocarcinomas were found in 24 (4.7%) patients (1991-2005, n=512), and 5 of them were diagnosed after 5 years of follow-up. Histopathologic examinations of the resected livers showed various degrees of pathologies from proliferative cholangitis and hyperplasia through dysplasia and cholangiocarcinoma. Therefore, a suspicion of malignancy and long term follow-up are needed for managing the patients who suffer with hepatolithiasis.
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Humans , Cholangiocarcinoma , Cholangitis , Drainage , Factor IX , Follow-Up Studies , Hepatectomy , Hyperplasia , Lithotripsy , Liver , RecurrenceABSTRACT
PURPOSE: Traditionally, the main treatment for common bile duct (CBD) stones and gallstones is ERCP combined with a laparoscopic cholecystectomy (LC). However, this procedure is generally performed in 2 stages, which makes the patients uncomfortable and unsatisfied. It also can result in the need for several procedures if it fails, and sometimes the surgery is warranted. Recently in the laparoscopic era, the laparoscopic skill has been developed quite rapidly. In the case of CBD stones, there are many reports involving laparoscopic procedures. We reviewed the safety and feasibility of removing CBD stones using a laparoscope and choledochoscope. METHOD: This retrospective study reviewed 40 cases who underwent a laparoscopic cholecystectomy and choledocholithotomy for bile duct stones between Feb. 2002 and Aug. 2004. RESULTS: Of the 40 patients who underwent the laparoscopic procedure, 25 were combined with gallstones, and 12 underwent the transcystic duct approach. The average operation time and average hospital stay was 141.2 mins and 11.3 days, respectively, and the average age was 69.4 year old. There was 1 case of a major complication, where bile leakage occurred for more than 14 days due to a shincter stenosis. This case was improved by an endoscopic sphincterotomy. Of them, 30 underwent a primary closure and 8 underwent T-tube drainage, 2 underwent a biliary stent. CONCLUSION: The laparoscopic cholecystectomy and choledocholithotomy using a choledochoscope are quite safe and feasible, can reduce the patient's anxiety, and increase their level of satisfaction.
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Humans , Anxiety , Bile , Bile Ducts , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Choledocholithiasis , Common Bile Duct , Constriction, Pathologic , Drainage , Gallstones , Laparoscopes , Length of Stay , Retrospective Studies , Sphincterotomy, Endoscopic , StentsABSTRACT
Objective To discuss the feasibility of stone removal in laparoscopic choledocholithotomy by routine laparotomic instruments. Methods A total of 73 patients with common bile duct stones were divided randomly into 2 groups: the Experimental Group received laparoscopic stone removal by routine laparotomic instruments; the Control Group received stone removal by choledochoscopic net-basket. The stone-free rate, operative time, total hospitalization costs and postoperative complications between the two groups were compared. Results There were no statistical significances in stone-free rate between the Experimental Group ( 94.4% , 34/36) and the Control Group (94.6%, 35/37) ( ? 2=0.000, P =1.000). The operative time in the Experimental Group (150.9 min?26.8 min) was shorter than that in the Control Group (172.3 min?28.6 min) ( t=3.297, P =0.002), whereas the total hospitalization costs in the Experimental Group (4400 yuan?1100 yuan) was lower than that in the Control Group (5000 yuan?1300 yuan) ( t=2.126, P= 0.037). No severe operation-related complications were observed in both of the groups. Conclusions Laparoscopic choledocholithotomy by either routine laparotomic instruments or choledochoscopy is safe and effective. Stone removal by routine laparotomic instruments has the advantages of low costs and short operative time.
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Objective To compare the therapeutic results of laparoscopic and open treatment for choledocholithiasis. Methods A prospective comparison was conducted between 29 cases of laparoscopic choledocholithotomy and 35 cases of open choledocholithotomy in terms of stone removal,operative time,hospitalization day,hospitalization cost and postoperative complications. Results Stone removal was achieved in 28/29 patients by a laparoscopic approach and in 32/35 patients by a open approach( ? 2=0 71, P =0 399);average operative time was (178 3?32 4) min in laparoscopic approach and (145 8?27 1)min in open approach( t =4 27, P =0 01);the patients in laparoscopic procedures had flatus in (20 8?2 9) hour and those in open procedures did in (58 2?4 9) hours( t =37 8, P 0 05);no major complication was found in laparoscopic approach. Conclusions Laparoscopic choledocholithotomy is safe and effective and it is superier to open treatment.
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Objective To compare the clinical results of choledocholithotomy by laparoscopic surgery and open surgery.Methods One hundred and Sixty-nine patients with cholecystoithiasis combined with choledocholithiasis were divided into laparoscopic surgery group(85 cases of laparoscopic choledocholithotomy,LCD-TD) and open surgery group(84 cases of open choledocholithotomy,OCH-TD).The clinical data in the two groups were compared and analyzed.Results The amount of intraoperative bleeding,the recover time of intestinal peristalsis after treatment,length of hospital stay,cases of postoperative pain and biliary fistulas in laparoscopic surgery group were evidently better than those of open surgery group(all P