scholarly journals P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Critical View Of Safety ◽  
Novel Technique ◽  
Increased Risk ◽  
Time Required

Abstract Background Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD. Methods Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated. Results This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery. Conclusions The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated. 

scholarly journals LAPROSCOPIC COMMON BILE DUCT EXPLORATION: STENT DRAINAGE VERSUS T- TUBE DRAINAGE

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Gulshan Kumar
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Operating Time ◽  
Postoperative Mortality ◽  
Common Bile Duct Exploration ◽  
P Value ◽  
Tube Drainage ◽  
T Tube ◽  
Significant Difference

Introduction: One of the safe & feasible methods for the management of extra-hepatic bile duct calculi is laparoscopic bile duct exploration. Around 10-15% of the subjects who have surgery due to gallstone disease have choledocholithiasis associated with it. A standard procedure to prevent bile escape from the choledochotomy site is conventionally postoperative T-tube drainage following common bile duct exploration.  Aims & Objectives: Comparative study of laproscopic common bile duct exploration using stent drainage versus t- tube drainage. Material & Methods: The study involved a total of 46 subjects with choledocholithiasis, who were categoryed in 2 categorys. Category I as a drainage category of stents and Category 2 as a drainage category of T-tubes. The subjects in both classes underwent LCBDE surgery. Of the 46 subjects operated, 23 were in category I (stent drainage category) and 23 were in category 2 (T-tube drainage category).  Results:  23 subjects were categoryed in the stent drainage and T-tube drainage categories, respectively. In both classes, no perioperative or postoperative mortality was reported. Subjects had hypertension in stent drainage category 4 (17.39 percent) and 5 (21.73 percent) suffered from diabetes as a comorbid disease, while 2 (8.69 percent) subjects had jaundice. Four (17.39 percent) subjects with diabetes and three (13.04 percent) subjects with jaundice were found in T-tube drainage category 3 (13.04 percent) with hypertension. In both classes, no statistically significant difference was found. In terms of organisational results and outcomes, statistically significant variations were found in both categorys (Table 3). Mean operating time was 103± 22.4 in category I while 127±32.7 (P value < 0.005) in category II. In the Stent Drainage Category, blood loss during procedure was 22±3.7 ml, while in the T-tube drainage category it was 38±5.1 (P value < 0.005). Conclusion. After laparoscopic choledochotomy, primary closure of the bile duct with spontaneously reversible biliary stent placement is a viable and practicable process. With spontaneously removable biliary stents, less surgery time, less bleeding and less intestinal complications have been observed. Keywords: stent drainage, T- tube drainage, choledochotomy

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2019 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Dilatation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Non Invasive ◽  
Transcystic Approach ◽  
Surgical Modality ◽  
Cbd Exploration

Abstract The advent of endoscopic and laporoscopic techniques changed surgery in many regards. A number of options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct (CBD) exploration with the choledocotomy followed by laparoscopic cholecystectomy (LC) has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the CBD. For this purpose, we modified the surgical modality by laparoscopic transcystic approach with dilatation of the cystic duct confluence in CBD exploration (LTD-CBDE). The aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE based on our preliminary experience.

scholarly journals Laparoscopic Common Bile Duct Exploration for Choledocholithiasis During a Pregnancy: a Case Report

2016 ◽  
Vol 16 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Janis Lacis ◽  
Ieva Rancane ◽  
Haralds Plaudis ◽  
Evita Saukane ◽  
Guntars Pupelis
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Intraoperative Ultrasound ◽  
Common Bile Duct Exploration ◽  
Dynamic Imaging ◽  
Gallbladder Motility ◽  
Cbd Stones ◽  
Nulliparous Women

SummaryIn population studies, gallstones are found in 6.5% to 8.4% of nulliparous women, and in 18.4% to 19.3% of women with two to three or more pregnancies (7). Approximately 1 in 500 to 1 in 635 women will require non-obstetrical abdominal surgery during their pregnancies. Pregnancy induced physiological hormonal changes are associated with a decrease of gallbladder motility and increased cholesterol saturation of bile, leading to biliary stone formation (12,6,8). Surgical approach nowadays is the method of choice in the management of symptomatic gallstone disease during pregnancy, preferably if possible surgery should be postponed to second trimester (7,8).Preoperative radiologic imaging using magnetic resonance cholangiopancreatography is the golden standard for patients with suspected choledocholithiasis, however, its application during pregnancy is limited (9). Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be used before, during or after laparoscopic cholecystectomy when it is indicated, but unfortunately, its application during pregnancy is associated with considerable number of complications concerning mother and fetus. Alternative approach has been developed and recommended for patients with the common bile duct (CBD) stones providing laparoscopic common bile duct exploration (LCBDE). Intraoperative cholangiography or intraoperative ultrasound (IOUS) are the methods currently used for detection of the CBD stones during laparoscopic cholecystectomy, however, IOUS can be considered as the method of choice during pregnancy (3).IOUS is a dynamic imaging modality that provides interactive and timely information during surgical procedures. Because the transducer is in direct contact with the organ being examined, high-resolution images can be obtained that are not degraded by air, bone, or overlying soft tissue (1).

scholarly journals Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and stone extraction for Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Open Cholecystectomy ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Controlled Study ◽  
Stone Extraction ◽  
The Mean ◽  
Cbd Exploration

Abstract Objectives: Many options exist in the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with the choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made for minimally invasive or non-invasive to the common bile duct (CBD). For this purpose, we modified the surgical modality of laparoscopic transcystic approach by dilating the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, the aim of this work was to assess the feasibility, safety and effectivity of LTD-CBDE.Patients and methods: Sixty-eight patients were arbitrarily offered new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or the columnar dilation balloon. Subsequently, the CBD exploration and stone extraction were performed with choledochoscope. The entrance of CBD was covered with cystic duct stump wall and primarily closed at the end of surgery.Results: 49 females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 yr). Of which, 62 cases (91.2%) were performed with LTD-CBDE techniques successfully, bile leakage was observed in 3 cases (4.4%). The mean operation time was 106 minutes and the mean hospital stay was 5.9 days. As for the other 6 patients, 3 cases were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at the Calot’s triangle (n=2) and Mirizze syndrome (n=1); LCBDE were performed in 3 patients due to cystic duct atresia (n=2) and low level of the gallbladder duct into CBD (n=1). These patients had smooth postoperative course. None of the patients presented radiological evidence of retained CBD stone on the postoperative follow-up in 43/68 (40 cases used LTD-CBDE) patients one year later.Conclusion: The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low rate of complications. It offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled study is further needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

scholarly journals Dilation of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration and Stone Extraction in Patients with Secondary Choledocholithiasis

2020 ◽  
Author(s):  
Xiao-Bin Yang ◽  
An-Shu Xu ◽  
Jian-Gang Li ◽  
Yong-Ping Xu ◽  
De-Song Xu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Open Cholecystectomy ◽  
Operation Time ◽  
Common Bile Duct Exploration ◽  
Stone Extraction ◽  
Randomized Controlled Studies ◽  
The Mean ◽  
Cbd Exploration

Abstract Background: Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). For this purpose, we modified the surgical modality, exploring the use of laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE). Based on our preliminary experience, we can use this technique to resolve patients with secondary common bile duct stones, and the effect is better than placing T tubes.Methods: Sixty-eight patients were randomly offered the new LTD-CBDE technique from December 2015 to April 2018. During the surgery, we dilated the cystic duct confluence with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.Results: Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 minutes, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n=2) or Mirizze syndrome (n=1); LCBDE was performed in 3 patients due to cystic duct atresia (n=2) and low level of flow from the gallbladder duct into the CBD (n=1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) one year later.Conclusions: The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

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