Experience with laparoscopic common bile duct exploration in failed endoscopic retrograde cholangiopancreatography cases at a tertiary care hospital

Authors

  • Pradeep Panwar Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Hetish M. Reddy Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Rajendra Bagree Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Gaurav Jalendra Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20204134

Keywords:

Common bile duct, Choledocholithiasis, Laparoscopic, CBD exploration T-tube

Abstract

Background: Minimally invasive techniques for stone removal in common bile duct (CBD) are endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or laparoscopic CBD exploration with LC (laparoscopic common bile duct exploration (LCBDE) and LC). Failed, multiple attempted or complications of ERCP leads to other surgical approaches where LCBDE is a preferable option by experts due to its added benefits.

Methods:  We did LCBDE and LC in 40 cases of failed ERCP. Standard investigation protocol was followed in all cases and CBD were explored laparoscopically and stones were retrieved. Post retrieval choledochoscopy was done and sphincter of oddi was dilated by the dilators.

Results: With careful selection of cases, stone calculi were retrieved successfully in 38 cases by laparoscopically and 2 cases by open method after conversion. Postoperative choledochoscopy were found normal. Bile leak seen in 3 cases, which were managed conservatively. Standard regime of postoperative care was taken followed by T-tube removal after cholangiogram on day 10-14. All patients survived the operation.

Conclusion: We advocate that LCBDE is the most viable alternative for open surgery in failed ERCP cases for retrieval of CBD stones. This results in early recovery, better cosmetic scar, least complications with early resumption of routine life. Needs cautious patient selection and expertise in laparoscopic surgery.

Metrics

Metrics Loading ...

References

Salama AF, Abd Ellatif, Elaziz HA, Magdy A, Rizk H, Basheer M et al. Preliminary experience with laparoscopic common bile duct exploration. BMC Surg. 2017;17(1):32.

Savita KS, Bhartia VK. Laparoscopic CBD Exploration. Indian J Surg. 2010;72(5):395‐9.

Gupta P, Bhartia VK. Laparoscopic management of common bile duct stones: our experience. Indian J Surg. 2005;67:94-9.

Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J et al. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc. 1999;13:952-7.

Tai CK, Tang CN, Ha JPY, Chau CH, Siu WT, Li MKW. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc. 2004;18(6):910-14.

Dorman JP, Franklin ME, Jr Glass JL. Laparoscopic common bile duct exploration by choledochotomy. An effective and efficient method of treatment of choledocholithiasis. Surg Endosc. 1998;12:926-8.

Petelin J. Laparoscopic approach to common duct pathology. Surg Lap Endosc. 1991;1:33-41.

Appel S, Krebs H, Fern D. Techniques for laparoscopic cholangiography and removal of common duct stones. Surg Endosc. 1992; 6:134-7.

Dion YM, Morin J, Dionne G, Dejoie C. Laparoscopic cholecystectomy and choledocholithiasis. CJS. 1992;35:67-74.

Fanning NF, Horgan PG, Keane FBV. Evolving management of common bile duct stones in the laparoscopic era. J R Coll Surg Endinb. 1997;389-394.

Newman KD, Powell DM, HolcombIII GW. The management of choledocholithiasis in children in the era of laparoscopic cholecystectomy. J Ped Surg. 1997:32:1116-9.

Heili MJ, Wintz NK, Fowler DL. Choledocholithiasis: endoscopic versus laparoscopic management. Am Surg. 1999;65:135-8.

Rhodes M, Sussman L, Cohen L, Lewis MP. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet. 1998;351:159-61.

Croce E, Faggioni A, Jakimowicz J, lacy A, Lezoche E, Morino M et al. EAES ductal stone study: preliminary fi ndings of multi-center prospective randomized trial comparing two-stage vs. single-stage management. Surg Endosc. 1996;10:1130-35.

Frazee RC, Roberts J, Symmonds R, Hendricks JC, Snyder S, Smith R et al. Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis. Am J Surg. 1993;166:702-6.

Downloads

Published

2020-09-23

Issue

Section

Original Research Articles