Laparoscopic cholecystectomy combined with normal-sized common bile duct exploration for cholecystolithiasis and choledocholithiasis / 中华普通外科杂志

Objective:To evaluate laparoscopic choledocholithotomy in patients with cholecystolithiasis and normal sized common bile duct(CBD) with choledocholithiasis.Methods:The clinical data of 393 patients with cholecystolithiasis and choledocholithiasis treated by LC combined with LCBDE at the Department of General Surgery of Hefei Second People's Hospital from Mar 2014 to Jul 2021 were retrospectively analyzed.Results:There were 280 CBD calculi cases in which CBD diameter >8 mm which was included into CBD dilated group, and 113 cases of CBD calculi with normal diameter (5 mm≤CBD diameter ≤8 mm). There was no difference in operative time and postoperative complications in the small diameter group. During the follow-up period, 1 case in the dilated group experienced biliary tract stenosis and treated by stenting. There was no statistical significance in biliary tract stenosis in both groups ( P>0.05).Stone recurrence occurred in 3 cases (2.7%) in the normal diameter group, all of which were removed by ERCP lithotomy. Stone recurrence occurred in 8 cases (2.9%) in the CBD dilated group, 7 were removed by ERCP stone extraction and 1 refused further treatment. Conclusion:It is safe and feasible to perform LC+LCBDE in patients with cholecystolithiasis complicating normal sized CBD stones.

Controversias en cirugía: colelitiasis y coledocolitiasis ¿Exploración de vías biliares laparoscópica más colecistectomía laparoscópica (cirugía en un paso) o CPRE y colecistectomía laparoscópica (cirugía en dos pasos)? / Controversies in surgery: Cholelithiasis and choledocholithiasis - Laparoscopic bile duct exploration plus laparoscopic cholecystectomy (one-step surgery) or ERCP and laparoscopic cholecystectomy(two-step surgery)?

Introducción. La colelitiasis tiene una prevalencia del 15 % y el 21 % tendrá coledocolitiasis al momento de la colecistectomía, con 50 % de probabilidad de presentar complicaciones asociadas. Desde el advenimiento de la colecistectomía laparoscópica, el abordaje de la coledocolitiasis ha sido endoscópico, usualmente en un tiempo diferente al vesicular, sin embargo, los avances en laparoscopia han permitido explorar la vía biliar común por la misma vía, pudiendo realizar ambos procedimientos en el mismo tiempo de forma segura. Métodos. Se realizó una búsqueda de la literatura existente con relación al enfoque para el manejo de la colecisto-coledocolitasis en un paso comparado con dos pasos. Resultados. Existe evidencia que demuestra mayor efectividad del abordaje en dos pasos, con CPRE y posterior colecistectomía laparoscópica, sobre el abordaje en un paso, especialmente en la tasa de fuga biliar y de cálculos retenidos. El enfoque en un paso con exploración de vías biliares y colecistectomía laparoscópica en el mismo tiempo es seguro, con alta tasa de éxito, baja incidencia de complicaciones, menor estancia hospitalaria y costos. Conclusión. El abordaje laparoscópico en un solo paso es un procedimiento seguro y eficaz para el manejo de la colecisto-coledocolitiasis, con el beneficio de estancia hospitalaria menor, sin embargo, se requieren habilidades técnicas avanzadas en cirugía laparoscópica. En nuestro medio ya existe una infraestructura para el manejo híbrido con CPRE y colecistectomía laparoscópica, pudiéndose realizar ambos en el mismo tiempo, para reducir estancia y costos.

Introduction. Cholelithiasis has a prevalence of 15%, and 21% will have choledocholithiasis at the time of cholecystectomy, with a 50% probability of presenting associated complications. Since the advent of laparoscopic cholecystectomy, the approach to choledocholithiasis has been endoscopic, normative at a different time than the gallbladder; however, advances in laparoscopy have made it possible to explore the common bile duct by the same route, being able to perform both procedures in a single time safely. Methods. A search of the existing literature was performed regarding the one-step approach compared to the two-step approach for the management of cholelithiasis and choledocholithiasis. Results. There is evidence that demonstrates greater effectiveness of the two-step approach with ERCP and subsequent laparoscopic cholecystectomy over the one-step approach, especially in the rate of bile leak and the incidence of retained stones. The one-step approach with bile duct exploration and laparoscopic cholecystectomy at the same time is safe, with a high success rate, low incidence of complications, shorter hospital stay, and lower costs. Conclusion. The one-step laparoscopic approach is a safe and effective procedure for the management cholelithiasis and concomitant choledocholithiasis, with the benefit of a shorter hospital stay; however, advanced technical skills in laparoscopic surgery are required. In our environment there is already an infrastructure for hybrid management with ERCP and laparoscopic cholecystectomy, both of which can be performed at the same time to reduce hospital stay and costs.

Internal drainage tube versus T tube in laparoscopic common bile duct exploration / 中华肝胆外科杂志

Objective:To study the effect of internal drainage tube and T tube in laparoscopic common bile duct exploration.Methods:The data of 103 patients who underwent laparoscopic common bile duct exploration for the treatment of choledocholithiasis from January 2016 to April 2021 in Dongguan Kanghua Hospital were analyzed, including 50 males and 53 females, aged (50.3±17.2) years old, the age range was 15 to 90 years old. A total of 103 patients were randomly divided into T tube group ( n=60), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal+ T tube drainage, and self-dropping stent group ( n=43), who received laparoscopic cholecystectomy + choledocholithotomy and stone removal + placed with self-dropping stent. The operation time, intraoperative blood loss, postoperative drainage, postoperative hospital stay and incidence of postoperative complications were compared between the two groups. Results:The operation time of self-dropping stent group was (107.2±26.1) min, intraoperative blood loss 10(5, 10) ml, and postoperative hospital stay (6.5±3.5) d, which were better than those of T tube group (143.5±52.7) min, 10(10, 20) ml, (8.8±3.8) d, the differences were statistically significant (both P<0.05). There were no significant difference in postoperative drainage volume and postoperative complications between the two groups (both P>0.05). Conclusion:The internal drainage tube in laparoscopic common bile duct exploration is a safe and reliable surgical method for the treatment of choledocholithiasis, which can significantly shorten the hospitalization time of patients.

Laparoscopic Common Bile Duct Exploration for Treatment of Common Bile Duct Stones:Clinical Analysis of 158 Cases / 中国医学科学院学报

Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.

Clinical effect of laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction in for choledocholithiasis / 国际外科学杂志

Objective:To investigate the clinical effect of laparoscopic common bile duct exploration through Micro-incision of cystic duct and its junction in for choledocholithiasis.Methods:The clinical data of 62 patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of hepatobiliary and pancreatic surgery of Huangshi Central Hospital, Edong Healthcare Group from January 2017 to December 2021 were analyzed retrospectively, and were divided into two groups according to different treatment schemes. Among them, 32 cases underwent laparoscopic cholecystectomy, common bile duct exploration and lithotomy (primary suture group), Laparoscopic choledocholithotomy and exploration + T-tube drainage (T-tube Drainage Group) 30 cases. The general data, operation time, intraoperative bleeding, postoperative exhaust time, first time out of bed, postoperative hospital stay, 24-hour postoperative pain score and the incidence of total complications were compared between the two groups.Results:The operation was successfully performed in both groups, there was no perioperative death.There was no significant difference in general data, operation time, intraoperative bleeding and the incidence of total complications between the two groups ( P> 0.05), the postoperative anal exhaust time, the first time out of bed and the postoperative hospital stay in the primary suture group were (20.3±5.8) h, (15.5±4.3) h and (4.5±1.7) d, respectively, which were significantly shorter than those in the T-tube drainage group (28.3±7.9) h, (22.8±6.7) h and (7.0±2.8) d( P<0.05); The hospitalization cost in the primary suture group was (18 725.9±855.8) yuan, which was significantly lower than that in the T-tube drainage group (23 450.7±975.4) yuan ( P< 0.05). The 24-hour pain score (2.7±0.9) scores in the primary suture group was significantly lower than that in the T-tube drainage group (3.8±1.2) scores ( P< 0.05). Conclusion:Laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction is safe and effective, which can accelerate the rehabilitation of patients and reduce the cost of hospitalization, which is more in line with the concept of ERAS.

Litiasis coledociana de difícil resolución / Difficult common bile duct stones

RESUMEN Antecedentes: el manejo laparoscópico en un tiempo de la coledocolitiasis se acompaña de una tasa de éxito elevada en la mayoría de los casos. Una excepción a esto son los cálculos coledocianos difi cultosos. Objetivo: describir los resultados del manejo de cálculos coledocianos dificultosos. Material y métodos: revisión retrospectiva de una serie consecutiva de casos de cálculos coledocianos dificultosos tratados durante el período 2018-2020. Resultados: 8 pacientes cumplieron con el criterio de inclusión. El manejo en un tiempo por videola paroscopia (5 casos) tuvo un 60% de conversión a cirugía abierta. Los otros pacientes (3 casos) fueron manejados inicialmente con endoscopia biliar por colangitis grave y fueron resueltos luego en forma electiva por instrumentación transcística. Conclusión: esta experiencia inicial sugiere que el abordaje en dos tiempos podría favorecer la resolu ción mininvasiva de los cálculos coledocianos dificultosos.

ABSTRACT Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive approach.

Abordaje laparoscópico sistemático de la coledocolitiasis / Routine laparoscopic management of common bile duct stones

RESUMEN Antecedentes: la prevalencia conjunta de litiasis vesicular y coledociana aumenta con la edad y llega al 15% en la octava década de la vida. Su manejo continúa siendo controvertido: algunos profesionales prefieren el abordaje en un tiempo por videolaparoscopia, y otros, el abordaje en dos tiempos con endoscopia (CPRE preoperatoria) seguida de colecistectomía laparoscópica. Objetivo: evaluar la eficacia y seguridad del manejo en un tiempo por videolaparoscopia en pacientes consecutivos con diagnóstico de litiasis vesicular y coledociana. Material y métodos: estudio retrospectivo con datos de una base de datos prospectiva, entre julio de 2008 y julio de 2018. Resultados: sobre un total de 2447 colecistectomías laparoscópicas realizadas en el citado período, 416 (17%) presentaron litiasis coledociana. El éxito global de la vía transcística en la extracción de litiasis coledociana fue del 81,2%: del 70,4% en los casos con diagnóstico prequirúrgico de colestasis extrahepática litiásica y del 92,9% en los otros diagnósticos. La morbilidad fue del 4%, sin mortalidad ni lesiones quirúrgicas de la vía biliar. Conclusión : el manejo en un tiempo por videolaparoscopia es eficaz y seguro debido al elevado éxito global de la instrumentación transcística (ITC). El diagnóstico preoperatorio de coledocolitiasis condi ciona una disminución de esa eficacia, por mayor indicación de coledocotomía, con un aumento de la morbilidad y del tiempo de internación.

ABSTRACT Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.

Effect of laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis / 国际外科学杂志

Objective:To investigate the effect of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (LCBDE) on pain stress and inflammatory factors in elderly patients with gallbladder stones and common bile duct stones.Methods:Eighty elderly patients with cholecystolithiasis and choledocholithiasis in Huadong Hospital Affiliated to Fudan University from January 2020 to January 2021 were selected. According to the surgical method, they were divided into observation group of 40 cases and control group of 40 cases. Patients in the observation group were treated with LC combined with LCBDE, and patients in the control group were treated with traditional open surgery. The perioperative indicators and complications, changes in pain stress and inflammatory factors before and 3 days after operation, and the quality of life before operation, 1 month after operation and 6 months after operation were compared between the two groups. Normally distributed measurement data were represented by mean±standard deviation ( Mean± SD), and t test was used to compare between groups. The chi-square test was used to compare the count data between groups. Results:The operation time, time to get out of bed, postoperative exhaust time, intraoperative blood loss, and postoperative complications in the observation group were (98.39±7.23) min, (1.56±0.37) d, (1.29±0.28) d, (38.94±5.64) mL, 5%, the control group were (107.53±9.98) min, (2.53±0.52) d, (2.16±0.34) d, (65.87±7.96) mL, 25%, the observation group were excellent in all indicators compared with the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum 5-hydroxytryptamine, substance P and norepinephrine in the two groups were higher than before operation ( P<0.05); after operation 3rd day, serum 5-hydroxytryptamine, substance P and norepinephrine the observation group were (0.70±0.12) pg/mL, (175.42±17.87) ng/mL and (378.52±26.57) ng/mL, the control group were (1.02±0.18) pg/mL, (248.98±18.98) ng/mL, and (460.92±35.42) ng/mL. The indexes of the observation group were smaller than those of the control group, the differences between the two groups were statistically significant ( P<0.05). After operation 3rd day, the serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the two groups were higher than before operation ( P<0.05); after operation 3rd day, Serum tumor necrosis factor-α, C-reactive protein and interleukin-6 in the observation group were (108.76±10.86) pg/mL, (14.23±3.18) mg/L and (17.84±3.98) pg/mL, respectively, on the 3rd day after operation. The control group were (156.95±16.67) pg/mL, (26.52±4.59) mg/L and (28.53±5.67) pg/mL, the observation group indexes were all smaller than control group, the differences between the two groups were statistically significant ( P<0.05). The quality of life scores of the two groups at 1 month and 6 months after the operation were higher than before operation ( P<0.05); The quality of life scores of patients in the observation group at 1 month and 6 months after surgery were higher than control group ( P<0.05). Conclusion:LC combined with LCBDE treatment has little effect on pain stress and inflammatory factors in elderly patients with cholecystolithiasis and choledocholithiasis, and has fewer postoperative complications, and can improve the quality of life of patients.

Application of needle-type choledochotomy in laparoscopic common bile duct exploration / 国际外科学杂志

Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.

Tratamiento de la coledocolitiasis mediante CPRE e instrumentación a través de un tubo en T / Treatment of choledocholithiasis by ERCP, and instrumentation through a T-tube

Resumen El tratamiento de la coledocolitiasis ha evolucionado de forma significativa desde que Robert Abbe realizó la primera coledocotomía y la exploración de las vías biliares en Nueva York, en 1889. La colangiopancreatografía retrógrada endoscópica (CPRE), que inicialmente fue un método diagnóstico, ahora solo tiene validez como método terapéutico. En la actualidad, los principales métodos diagnósticos son la colangioresonancia magnética (CRM) y la ultrasonografía endoscópica (USE). El tratamiento de la coledocolitiasis pasó de la técnica quirúrgica abierta -en la que, de forma rutinaria, se realizaba la coledocorrafia sobre un tubo de Kehr o tubo en T- a la endoscópica, mediante el uso de la CPRE, la esfinteroplastia y la instrumentación con balones y canastilla. Hoy en día se dispone de técnicas adicionales como la litotricia mecánica (LM) o extracorpórea, la dilatación con balón (DB) de gran tamaño y el Spyglass ® . La técnica laparoscópica se usa desde hace varios años, en diversas partes del mundo, para el tratamiento de la coledocolitiasis. Estudios recientes proponen incluso el cierre primario del colédoco o la coledocoduodenostomía, con lo cual no sería necesaria la utilización del tubo en T. Pero en muchos otros sitios, y por diversas razones, se continúa usando la exploración quirúrgica abierta y el tubo en T, que representa una importante opción en el tratamiento de algunos pacientes. Caso clínico: paciente masculino de 88 años, con coledocolitiasis recidivante, cálculo gigante de difícil manejo endoscópico y sepsis de origen biliar, que requirió drenaje quirúrgico abierto de urgencias. Se realizó una coledocotomía, y se dejó el tubo en T. Posteriormente, se efectuó un tratamiento exitoso conjunto, mediante instrumentación por el tubo en T, por parte de cirugía general, y CPRE, por gastroenterología.

Abstract The treatment of choledocholithiasis has evolved significantly since Robert Abbé performed the first bile duct exploration via choledochotomy in New York in 1889. Endoscopic retrograde cholangiopancreatography (ERCP), which was initially used for diagnosis, is now only valid as a therapeutic tool. Currently, the main diagnostic methods are magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The treatment of choledocholithiasis moved from the open surgery in which biliary stenting was routinely performed on a Kehr tube or T-tube, to the endoscopic technique using ERCP, sphincteroplasty and instrumentation with balloons and baskets. Additional techniques are now available such as mechanical or extra-corporeal lithotripsy, endoscopic papillary large balloon dilation and SpyGlass cholangioscopy. The laparoscopic technique has been used for several years in different parts of the world for the treatment of choledocholithiasis. Recent studies even propose performing the primary closure of the bile duct or choledochoduodenostomy, so that the T-tube is not necessary. However, in many other places, and for a variety of reasons, open exploratory surgery and the T-tube continue to be used, being an important option in the treatment of some patients. Case presentation: 88-year-old male patient with recurrent choledocholithiasis and a giant gallstone that was difficult to treat endoscopically, with sepsis of biliary origin, which required open surgical drainage at the emergency room. Choledocotomy was performed, and a T-tube was inserted at the site. Subsequently, a successful joint treatment was performed by the General Surgery Service and the Gastroenterology Service, using T-tube instrumentation and ERCP, respectively.

Acupuncture Combined with Early Enteral Nutrition on Patients with Postoperative Laparoscopic Common Bile Duct Exploration: A Prospective Randomized Trial / 中国结合医学杂志

OBJECTIVE@#To assess the efficiency of acupuncture combined with early enteral nutrition (EEN) in patients with postoperative laparoscopic common bile duct exploration.@*METHODS@#A total of 200 patients with postoperative laparoscopic bile duct exploration was randomized using sealed envelopes and assigned to the convenitional, EEN, acupuncture plus convenitional and acupuncture plus EEN groups, 50 cases in each group. Twelve hours after operation, the patients in EEN groups began to receive oral enteral nutrition, and the acupuncture approach was performed by acupuncturist in acupuncture plus conventional and acupuncture plus EEN groups. Acupuncture was given at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) with a depth of 15-20 mm, using the lifting-thrusting and twisting method to obtain Deqi sensation. The needles were maintained for 30 min. Treatment was given once daily, 3 times per section. After the intervention, the patients' characteristics, operation time, bleeding volume, postoperative time to first anal exhaust, postoperative complications including abdominal distension, diarrhea, gastric dilatation, intestinal obstruction, pharyngodynia, incision, abdominal and pulmonary infection and postoperative hospitalization days were assessed and compared in patients among 4 groups.@*RESULTS@#Postoperative time to first anal exhaust in the convenitional group was longer compared with the other 3 groups (P<0.05), and was shorter in the acupuncture plus EEN group than those of the convenitional, acupuncture plus convenitional and EEN groups (P<0.01). The acupuncture plus EEN group showed significant decrease in the incidence of complications and less postoperative hospitalization days compared with the other groups (P<0.05 or P<0.01). There was no readmission.@*CONCLUSION@#After laparoscopic bile duct exploration, acupuncture combined with EEN treatment significantly improves the patients' gastrointestinal function, reduces complications, and shortens postoperative hospitalization days.

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones / 中国基层医药

Objective@#To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.@*Methods@#Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded.@*Results@#In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ2=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ2=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05).@*Conclusion@#The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.

Clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration / 中华消化外科杂志

Objective@#To investigate the clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 13 patients with retroperitioneal abscess after common bile duct exploration who were admitted to Xinjiang Autonomous Region Hospital of Chinese People′s Armed Forces between January 2004 and December 2018 were collected.There were 5 males and 8 females, aged from 34 to 81 years, with an average age of 57 years. All the 13 patients underwent debridement and drainage for retroperitioneal abscess under percutaneous nephroscope. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up was performed using outpatient examination and telephone interview to detect postoperative choledocholithiasis recurrence up to September 2019. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers.@*Results@#(1) Surgical and postoperative situations: all the 13 patients underwent successfully debridement and drainage for retroperitioneal abscess under percutaneous nephroscope, without kidney injury, pancreatic damage, vascular injury or peritoneal damage. There were 11 cases with 1 drainage tube, and 2 cases with 2 drainage tubes. The operation time, volume of intraoperative pus extracted, time to body temperature resuming to normal of 13 patients were 41 minutes (range, 24-77 minutes), 241 mL (range, 110-640 mL), 1.5 days (range, 1.0-4.0 days), respectively. The time to postoperative removal of drainage tube of 13 patients was 42 days(range, 5-94 days), in which the time to postoperative removal of drainage tube at right iliac region was 5 days and 11 days in 2 patients, and at lower back was 23-94 days in 11 patients, respectively. Duration of postoperative hospital stay was 42 days (range, 26-67 days). All the 13 patients had pleural effusion disappeared, and were cured and discharged. (2) Follow-up: 13 patients were followed up for 6-48 months, with a median time of 18 months. No recurrence occurred.@*Conclusion@#The treatment with percutaneous nephroscopy is safe and effective for retroperitioneal abscess after common bile duct exploration.

Clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration / 中华消化外科杂志

Objective To investigate the clinical efficacy of percutaneous nephroscopy in the treatment of retroperitioneal abscess after common bile duct exploration.Methods The retrospective and descriptive study was conducted.The clinical data of 13 patients with retroperitioneal abscess after common bile duct exploration who were admitted to Xinjiang Autonomous Region Hospital of Chinese People's Armed Forces between January 2004 and December 2018 were collected.There were 5 males and 8 females,aged from 34 to 81 years,with an average age of 57 years.All the 13 patients underwent debridement and drainage for retroperitioneal abscess under percutaneous nephroscope.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up was performed using outpatient examination and telephone interview to detect postoperative choledocholithiasis recurrence up to September 2019.Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers.Results (1) Surgical and postoperative situations:all the 13 patients underwent successfully debridement and drainage for retroperitioneal abscess under percutaneous nephroscope,without kidney injury,pancreatic damage,vascular injury or peritoneal damage.There were 11 cases with 1 drainage tube,and 2 cases with 2 drainage tubes.The operation time,volume of intraoperative pus extracted,time to body temperature resuming to normal of 13 patients were 41 minutes (range,24-77 minutes),241 mL (range,110-640 mL),1.5 days (range,1.0-4.0 days),respectively.The time to postoperative removal of drainage tube of 13 patients was 42 days (range,5-94 days),in which the time to postoperative removal of drainage tube at right iliac region was 5 days and 11 days in 2 patients,and at lower back was 23-94 days in 11 patients,respectively.Duration of postoperative hospital stay was 42 days (range,26-67 days).All the 13 patients had pleural effusion disappeared,and were cured and discharged.(2) Follow-up:13 patients were followed up for 6-48 months,with a median time of 18 months.No recurrence occurred.Conclusion The treatment with percutaneous nephroscopy is safe and effective for retroperitioneal abscess after common bile duct exploration.

Analysis of treatments for 86 cases type Ⅲa hepatolithiasis without hepatectomy / 中国实用外科杂志

OBJECTIVE: To explore therapeutic strategies of type Ⅲa hepatolithiasis. METHODS: The clinical data of 86 patients with type Ⅲ a hepatolithiasis admitted from July 2014 to December 2017 in Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi University of Chinese Medicine were retrospectively analyzed. Patients without liver resection were included. Variables including residual stones,times of choledochoscopy performing,stone clearance rate and recurrence rate were observed. RESULTS: There was a total of 23 patients with biliary strictures and 2 cases of bile leakage after operation,83 patients(96.5%) residual stones after Initial treatment. About six weeks after surgery,the choledochoscopy was performed via T tube sinus or subcutaneous blind loop. The median lithotomy times was 3. There were 4 cases of residual small stones,and stone clearance rate was 95.4%. Median follow-up time was 24 months. 6 patients(7.0%) had recurrent intrahepatic bile duct stones,and the proficiency was 93.0%(80/86). 6 patients(7.0%) had sporadic cholangitis. CONCLUSION: It is safe and feasible to correct the stricture and remove the stones through the combination of biliary surgery and choledochoscope for type Ⅲa hepatolithiasis. The short-term outcomes are satisfactory.

Micro-incision of cystic duct and its junction in laparoscopic common bile duct exploration for chole-docholithiasis / 中华肝胆外科杂志

Objective To analyze our experience in laparoscopic common bile duct ( CBD) explo-ration using a 5 mm choledochoscope through a micro-incision at the junction between the cystic duct and the CBD for patients with choledocholithiasis and cholecystolithiasis. Methods From January 2014 to May 2018, laparoscopic common bile duct exploration through a micro-incision at the cystic duct-CBD junction was performed in 77 patients with choledocholithiasis and cholecystolithiasis at Beijing Tongren Hospital, Capital Medical University. Results Laparoscopic common bile duct exploration was performed successfully through a micro-incision in 77 patients with primary suturing of the micro-incision. The range of operation time, blood loss, and hospital stay were 65～150 min, 10～50 ml, and 4～9 d respectively. Seven patients developed minor bile leakage postoperatively and were treated successfully after 3 ～7 days of conservative treatment. Conclusion Common bile duct laparoscopic exploration using a choledochoscope for choledocho-lithiasis and cholecystolithiasis through a micro-incision at the junction of cystic duct and CBD was a safe and effective method.

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones / 中国基层医药

Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group (38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE),and B group (49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC).The curative effect of the two groups was observed.The operation time,the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery,and the complications of the two groups were recorded.Results In A group,the average diameter of common bile duct stones was (1.02 ± 0.25) cm,the average diameter of common bile duct diameter was (1.15 ± 0.25) cm.In B group,the mean diameter of common bile duct stones was (0.99 ± 0.26) cm,and the average diameter of common bile duct was (1.13 ± 0.26) cm.The differences between the two groups were not statistically significant (t =0.513,0.437,0.367,P =2.083,1.533,1.095).The successful operation rate of A group was 92.11％ (35/38),which in B group was 91.84％ (45/49),the difference was not statistically significant between the two groups (x2 =0.006,P =0.974).The incidence rate of complications in B group was 20.41％,which was significantly higher than that in A group,the difference was statistically significant(x2 =3.654,P =0.019).The hospitalization time,hospitalization expenses in A group were (10.6 ± 2.6) d,(26 649.8 ± 3 478.6) CNY,respectively,which were significantly better than those in B group (t =21.971,17.168,all P ＜ 0.05).Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery,and the safety of the former is higher than the latter.

Efficacy comparison of two minimally invasive operations on cholecystolithiasis combined with choledocholithiasis / 国际外科学杂志

Objective To compare the clinical efficacy of laparoscopic cholecystectomy(LC) + endoscopic sphincterotomy combined with balloon dilation(ESBD) with laparoscopic cholecystectomy(LC) + common bile duct exploration(LCBDE) on cholecystolithiasis combined with choledocholithiasis.Methods The clinical data of 102 patients with gallbladder stones with common bile duct stones from October 2015 to October 2017 were reviewed from the Second Affiliated Hospital of Chongqing Medical University.Forty eight patients received LC + ESBD and 54 patients subjected to LC ± LCBDE.The operation time,intraoperative blood loss,abdominal drainage time,antibiotic utilization rate,stone residue rate were compared between the two groups.Measurement data with normal distribution were represented as (Mean ± SD),and t test was used to compare between groups.Measurement data with skewed distribution were represented as M(P25,P75),Mann-whitney U test was used to compare between groups.Categorical variables were describedas counts and percentages and were compared using chi-square test.Results The operation time,intraoperative blood loss,postoperative abdominal drainage time,and antibiotic utilization rate in the LC + ESBD group were (108.0 ± 23.4) min,(18.0 ± 7.1) ml,(1.83 ± 1.57) d,and 47.9％(23/48).The LC +LCBDE groupa were (169.6±37.8) min,(86.4±37.0) ml,(4.80±2.02) d,and 87.0％ (47/54),respectively,there were statistically significant differences between the two groups(P ＜0.05).The stone residual rate of the LC + ESBD group was 0,and the LC + LCBDE group was 5.6％ (3/54),respectively.There was no significant difference between the two groups(P ＞ 0.05).Conclusions LC + ESBD and LC + LCBDE both are safe and effective methods to treat cholecystolithiasis combined with choledocholithiasis.However,some data of LC + ESBD group are better than the LC + LCBDE group,such as general anesthesia time,surgical trauma and recovery time.Therefore,compared with LC + LCBDE,LC + ESBD may be the more suitable operation type for patients who have cardiovascular diseases and poor tolerance.

Innovative hybrid technique for bile duct exploration in the treatment of choledocholithiasis

Introduction: Common bile stone disease (CBDS) is frequent and has potentially severe complications, such as acute biliary pancreatitis and cholangitis. Unnecessary and unplanned procedures should be avoided, so before choosing the best treatment of common bile duct lithiasis it is essential to have a proper diagnose. CBDS is currently treated by therapeutic endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic bile duct exploration (LCBDE). Results: The aim of this article is to present an innovative hybrid technique for common bile duct exploration, as an option for cases where the laparoscopic approach is not resolutive, avoiding the need for conversion to open approach technique. Conclusions: The hybrid technique has the same benefits as open and laparoscopic techniques, but without increasing material costs and with good resolution in complex cases of common bile duct stones. (AU)

Exploración laparoscópica de las vías biliares. Descripción de la técnica paso a paso. Video / Laparoscopic exploration of the bile ducts. Description of the technique step by step. Video

La exploración laparoscópica de las vías biliares (ELVB) constituye, hoy en día, una herramienta de gran utilidad en el tratamiento de la patología litiásica del árbol biliar, especialmente cuando técnicamente sea imposible realizar una pancreato-colangiografía retrógrada endoscópica (PCRE) o en los casos en los cuales este estudio no esté disponible. Método: Describir mediante un video nuestra técnica de ELVB paso a paso, en una paciente de 41 años quien consultó por presentar tinte ictérico en piel y mucosas, coluria e hipocolia. El ultrasonido abdominal reportó litiasis vesicular, dilatación de vías biliares intra y extra hepáticas, colédoco de 9 mm de diámetro y múltiples imágenes hiperecogénicas sugestivas de litiasis. Al no poder realizarse PCRE se decide practicar ELVB. Se realizó disección del triángulo biliocístico, identificación y ligadura proximal del conducto cístico con la finalidad de evitar la migración de cálculos a la vía biliar durante el procedimiento, coledocotomía, lavado proximal y distal de la vía biliar, exploración con catéter de Fogarty, coledocorrafia primaria, cisticotomía y colocación de catéter para colangiografía intraoperatoria, constatación de plenificación de las vías biliares sin imágenes de defecto y de adecuado paso del contraste al duodeno, colecistectomía y colocación de drenaje subhepático. Resultados: Paciente evoluciona en forma satisfactoria, egresando al tercer día de postoperatorio sin eventualidades. Discusión: La ELVB con coledocorrafia primaria ha sido descrita como una alternativa viable y efectiva para el manejo de la litiasis biliar, destacando su menor morbimortalidad cuando se compara con procedimientos endoscópicos como la PCRE(AU)

Laparoscopic common bile duct exploration (LCBDE) constitutes, nowadays, a very useful tool in the treatment of biliary tree lithiasis, especially when it is technically impossible to perform an endoscopic retrograde pancreatic cholangiography (ERCP) or in cases when this study is not available. Method: Using a video, we describe our LCBDE technique step by step, in a 41-year-old patient who consulted for presenting jaundiced skin and mucosa, coluria and hypocolia. Abdominal ultrasound reported gallstones, intra- and extra-hepatic bile duct dilation, a 9-mm diameter common bile duct (CBD) and multiple hyperechoic images suggestive of lithiasis. Since ERCP could not be performed, it was decided to practice LCBDE. Dissection of the Calot's triangle was performed, identification and proximal ligation of the cystic duct in order to avoid migration of stones to the common bile duct during the procedure, choledochotomy, proximal and distal lavage of the bile duct, exploration with a Fogarty catheter, primary closure of CBD, cysticotomy and placement of catheter for intraoperative cholangiography, verification of fullness of the bile ducts without defect images and adequate passage of contrast to the duodenum, cholecystectomy and placement of subhepatic drainage. Results: Patient progressed satisfactorily, being discharged on the third postoperative day, uneventfully. Discussion: LCBDE with primary closure of CBD has been described as a viable and effective alternative for the management of biliary stones, highlighting its lower morbidity and mortality when compared with endoscopic procedures such as ERCP(AU)