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      A decade of washing out common bile duct stones with papillary balloon dilatation as a one-stage procedure during laparoscopic cholecystectomy

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          Abstract

          Background

          Laparoscopic cholecystectomy is the treatment of choice for the management of cholecystolithiasis. For the management of choledocholithiasis, a number of options exist. The effectiveness of washing out common bile duct stones with laparoscopic transcystic papillary balloon dilatation (LTPBD) in patients undergoing laparoscopic cholecystectomy (LC) as a one-stage procedure was evaluated.

          Methods

          Retrospectively, the files of 63 patients treated with LTPBD in a one-stage procedure undergoing laparoscopic cholecystectomy between December 1996 and December 2006 were studied.

          Results

          Fifty-three patients were treated successfully in a one-stage procedure, seven patients were treated in two steps with an endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and in three cases a conversion to open surgery was required. The median operation time was 128 min, and the median hospital stay was 4 days. No patients developed postoperative pancreatitis. In one case contrast leakage from the common bile duct was detected. It was the only complication directly related to the LTPBD. There were no postoperative deaths.

          Conclusions

          We consider the wash out of common bile duct stones after LTPBD in a one-stage procedure to be an easy to do and safe operation with great results. Cooperation with an intervention radiologist and application of an angioplastic dilatation dotter balloon catheter are the keys to success in this procedure. In our hospital, it is the treatment of choice for choledocholithiasis associated with cholelithiasis.

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          Laparoscopic exploration of common bile duct in difficult choledocholithiasis.

          Joe P Y Ha, Shirley W I Siu, Dora K C Tai … (2004)
          This review investigated the role played by laparoscopic exploration of the common bile duct (LECBD) in the management of difficult choledocholithiasis. This retrospective study reviewed a prospective database of LECBD for difficult choledocholithiasis during the period 1995 to 2003. Of the 97 LECBDs performed in the authors' center from 1995 to 2003, 25 were performed for difficult choledocholithiasis. Difficult choledocholithiasis was defined as failure of endoscopic stone retrieval for the following reasons: access and cannulation difficulty, the difficult nature of common bile duct (CBD) stones, and the presence of endoscopic retrograde cholangiopancreatography (ERCP)-related complications. There were seven unsuccessful cannulations because of previous gastrectomy (n = 5) and periampullary diverticulum (n = 2). Among the 18 patients with failed endoscopic extraction, there were 10 impacted stones, 2 incomplete stone clearances after multiple attempts, 2 type 2 Mirizzi syndromes, 1 proximal stent migration, 1 repeated post-ERCP pancreatitis, 1 situs inversus, and 1 stricture at the distal common bile duct. There were 14 male and 11 female patients with a mean age of 67.8 +/- 15 years. Initial presentations included cholangitis (n = 14, 56%), biliary colic (n = 3, 12%), jaundice/deranged liver function ( n = 5, 20%), cholecystitis (n = 2, 8%), and pancreatitis (n = 1, 4%). Regarding the approach for LECBD, there were 2 transcystic duct explorations and 23 choledochotomies. The mean operative time was 149.4 +/- 49.3 min, and there were three conversions (12%). The stone clearance rate was 100%, and no recurrence was detected during a mean follow-up period of 16.8 months. Five complications were encountered, which included bile leak (3 patients) and wound infection (2 patients). When the results were compared with the remaining 72 LECBDs for nondifficult stones during the same period, the complication rate, conversion rate, and rate of residual stones were similar despite a longer operation time (149.4 +/- 49.4 min vs 121.6 +/- 50.5 min). When ERCP is impossible or stone retrieval is incomplete, LECBD is the solution to difficult CBD stones.
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            Laparoscopic transcystic duct common bile duct exploration.

            Scott E. Phillips, S Lyass (2006)
            The modern era of common bile duct (CBD) surgery started with Mirizzi, who introduced intraoperative cholangiography in 1932. Intraoperative choledoscopy had been developed as an adjunctive to intraoperative cholangiography, which helped to detect CBD stones in an additional 10% to 15% of instances that otherwise would have been missed. Findings have shown choledochoscopy to be an important technique for efficient and effective management of CBD stones. Efforts to treat patients with common duct stones in one session and to avoid the potential complications of endoscopic sphincterotomy resulted in several laparoscopic transcystic CBD (LTCBDE) techniques. The techniques of transcystic stone extraction include lavage, trolling with wire baskets or biliary balloon catheters, cystic duct dilation, biliary endoscopy, and stone retrieval with wire baskets under direct vision and antegrade sphincterotomy, lithotripsy, and catheter techniques. The indications for LTCBDE are filling or equivocal defects at cholangiography, stones smaller than 10 mm, fewer than 9 stones, and possible tumor. The contraindications are stones larger than 1 cm, stones proximal to the cystic duct entrance into the CBD, small friable cystic duct, and 10 or more stones. Experience with LTCBDE shows that the approach is applicable in more than 85% of cases, with a success rate of 85% to 95%. It also is shown to be more cost effective than postoperative endoscopic retrograde cholangiopancreatography. Recent developments in LTCBDE have focused mainly on implementation of robotically assisted surgery and new imaging methods such as magnetic resonance cholangiopancreatography with three-dimensional virtual cholangioscopy and three-dimensional ultrasound. Further technological advances will facilitate the application of laparoscopic approaches to the common duct, which should become the primary strategy for the great majority of patients.
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              Use of the laparoscopic-endoscopic approach, the so-called "rendezvous" technique, in cholecystocholedocholithiasis: a valid method in cases with patient-related risk factors for post-ERCP pancreatitis.

              F Lella, E. Colombo, F Bagnolo … (2006)
              Several studies have shown the efficacy and effectiveness of the combined endoscopic-laparoscopic "rendezvous" technique for treatment of gallbladder and bile duct stones without complications, particularly pancreatitis. The so-called rendezvous technique consists of laparoscopic cholecystectomy standards with intraoperative cholangiography followed by endoscopic sphincterotomy (EST). The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. This method allows easier and faster cannulation, thus avoiding papillary edema and pancreatic trauma. The aim of this study was to evaluate whether this method is effective in eliminating ductal stones and to verify whether the risk of postprocedure pancreatitis is diminished. From January 2002 to September 2004, we enrolled 256 patients with cholecystocholedolithiasis detected by transabdominal ultrasound and magnetic resonance cholangiopancreatography. One hundred and twenty of these had one or more patient-related risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, so they were randomized into two groups of 60 patients. In group A, the patients were treated in a single step with videolaparoscopic cholecystectomy, intraoperative cholangiography, and EST during the surgical procedure with the rendezvous technique. In group B, preoperative ERCP and EST were performed by using a traditional method of bile duct cannulation. No cases of post-ERCP pancreatitis were observed in group A, whereas six cases of acute post-ERCP pancreatitis occurred in group B (five mild and one moderate) (p = 0.0274). No procedure-related mortality was recorded. In cholecysthocholedocholithiasis, the combined laparoscopic-endoscopic approach prevents post-ERCP pancreatitis in cases with patient-related risk factors for this complication.
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                Author and article information

                Contributors
                : aebsjer@gmail.com
                : D.Boland@llz.nl
                Journal
                Journal ID (nlm-ta): Surg Endosc
                Title: Surgical Endoscopy
                Publisher: Springer-Verlag (New York )
                ISSN (Print): 0930-2794
                ISSN (Electronic): 1432-2218
                Publication date (Electronic): 23 February 2010
                Publication date PMC-release: 23 February 2010
                Publication date (Print): September 2010
                Volume: 24
                Issue: 9
                Pages: 2226-2230
                Affiliations
                [1 ]Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
                [2 ]Department of Surgery, ‘t Lange Land Hospital, P.O. Box 3015, 2725 NA Zoetermeer, The Netherlands
                [3 ]Department of Radiology, ‘t Lange Land Hospital, Zoetermeer, The Netherlands
                Article
                Publisher ID: 937
                DOI: 10.1007/s00464-010-0937-x
                PMC ID: 2939343
                PubMed ID: 20177926
                SO-VID: e085f292-3eb6-4edc-ad01-00d427a6342c
                Copyright © © The Author(s) 2010
                History
                Date received : 25 February 2009
                Date accepted : 17 September 2009
                Categories
                Subject: Article
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC 2010

                ScienceOpen disciplines: Surgery
                Keywords: papillary balloon dilatation,cholelithiasis,laparoscopic cholecystectomy,one-stage procedure,choledocholithiasis,common bile duct stones
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: papillary balloon dilatation, cholelithiasis, laparoscopic cholecystectomy, one-stage procedure, choledocholithiasis, common bile duct stones

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