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      Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

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          Abstract

          Background

          Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single‐stage management of choledocholithiasis.

          Methods

          A retrospective multi‐institutional study among 17 centers with proven experience in LBDE was performed. A cross‐sectional survey consisting of a semi‐structured pretested questionnaire was distributed covering the main aspects on the use of LBDE in the management of choledocholithiasis.

          Results

          A total of 3950 LBDEs were analyzed. The most frequent indication was jaundice (58.8%). LBDEs were performed after failed ERCP in 15.2%. The most common approach used was the transcystic (63.11%). The overall series failure rate of LBDE was 4% and the median rate for each center was 6% (IQR, 4.5‐12.5). Median operative time ranged between 60‐120 min (70.6%). Overall morbidity rate was 14.6%, with a postoperative bile leak and complications ≥3a rate of 4.5% and 2.5%, respectively. The operative time decreased with experience ( P = .03) and length of hospital stay was longer in the presence of a biliary leak ( P = .04). Current training of LBDE was defined as poor or very poor by 82.4%.

          Conclusion

          Based on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs.

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          Most cited references30

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          Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline

          Main Recommendations ESGE recommends offering stone extraction to all patients with common bile duct stones, symptomatic or not, who are fit enough to tolerate the intervention. Strong recommendation, low quality evidence. ESGE recommends liver function tests and abdominal ultrasonography as the initial diagnostic steps for suspected common bile duct stones. Combining these tests defines the probability of having common bile duct stones. Strong recommendation, moderate quality evidence. ESGE recommends endoscopic ultrasonography or magnetic resonance cholangiopancreatography to diagnose common bile duct stones in patients with persistent clinical suspicion but insufficient evidence of stones on abdominal ultrasonography. Strong recommendation, moderate quality evidence. ESGE recommends the following timing for biliary drainage, preferably endoscopic, in patients with acute cholangitis, classified according to the 2018 revision of the Tokyo Guidelines: – severe, as soon as possible and within 12 hours for patients with septic shock – moderate, within 48 – 72 hours – mild, elective. Strong recommendation, low quality evidence. ESGE recommends endoscopic placement of a temporary biliary plastic stent in patients with irretrievable biliary stones that warrant biliary drainage. Strong recommendation, moderate quality of evidence. ESGE recommends limited sphincterotomy combined with endoscopic papillary large-balloon dilation as the first-line approach to remove difficult common bile duct stones. Strong recommendation, high quality evidence. ESGE recommends the use of cholangioscopy-assisted intraluminal lithotripsy (electrohydraulic or laser) as an effective and safe treatment of difficult bile duct stones. Strong recommendation, moderate quality evidence. ESGE recommends performing a laparoscopic cholecystectomy within 2 weeks from ERCP for patients treated for choledocholithiasis to reduce the conversion rate and the risk of recurrent biliary events. Strong recommendation, moderate quality evidence.
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            The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis

            The aim of this study was to compare the efficacy and safety of the laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) with preoperative endoscopic sphincterotomy (pre-EST) and LC for concomitant gallstones and common bile duct (CBD) stones.
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              Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis

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                Author and article information

                Contributors
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                Journal
                Journal of Hepato-Biliary-Pancreatic Sciences
                J Hepato Biliary Pancreat
                Wiley
                1868-6974
                1868-6982
                December 2022
                February 17 2022
                December 2022
                : 29
                : 12
                : 1283-1291
                Affiliations
                [1 ] Department of General, Visceral and Transplantation Surgery Clinic and University Hospital Virgen de la Arrixaca IMIB‐ARRIXACA Murcia Spain
                [2 ] University Hospital Monklands Airdrie UK
                [3 ] University of Glasgow Glasgow UK
                [4 ] Departments of Surgical Disciplines All India Institute of Medical Sciences New Delhi India
                [5 ] Department of Visceral Surgery University Hospitals KU Leuven Leuven Belgium
                [6 ] Department of General Surgery Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases Beijing Friendship Hospital Capital Medical University Beijing China
                [7 ] Division of General and Digestive Surgery Department of Surgery Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
                [8 ] Department of General and Digestive Surgery Hospital Universitari de Tarragona Joan XXIII Tarragona Spain
                [9 ] Department of Surgery Aberdeen Royal Infirmary Foresterhill Health Campus Aberdeen UK
                [10 ] Department of Hepatobiliary Surgery Hospital Universitario de Toledo Toledo Spain
                [11 ] Hepatobiliary and Pancreatic Surgery Unit Valme University Hospital Sevilla Spain
                [12 ] Departament of General Surgery Royal Blackburn Hospital NHS Trust Burnley UK
                [13 ] Department of Surgery Central Finland Hospital Nova Jyväskylä Finland
                [14 ] Department of Medicine Dentistry and Biotechnology University “G. d’Annunzio” of Chieti‐Pescara Pescara Italy
                [15 ] Department of General Surgery and Surgical Specialties "Paride Stefanini" Sapienza University of Rome Rome Italy
                [16 ] Department of Laparoscopic and Endoscopic Surgery National Center for Minimally Invasive Surgery Havana Cuba
                [17 ] Institute of Laparoscopic, Endoscopic and Bariatric Surgery Max Super Speciality Hospital Dehradun India
                [18 ] Department of Upper GI Surgery London North West University Healthcare London UK
                Article
                10.1002/jhbp.1123
                55fd6970-7ef4-4eae-9fa5-3ca066fc2491
                © 2022

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