Laparoscopic CBD exploration using a V-shaped choledochotomy

BMC Surgery

Tae Ho Hong¹  Jun Suh Lee¹  Soo Ho Lee¹  Eun Young Kim¹ 

[1] Department of Hepatobiliary and Pancreatic Surgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

关键词: Laparoscopy;    Cholelithiasis;    Choledocholithiasis;   

Others  :  1204295
DOI  :  10.1186/s12893-015-0050-0

 received in 2015-02-08, accepted in 2015-05-04,  发布年份 2015

【 摘 要 】

Background

Laparoscopic common bile duct exploration (LCBDE) is a treatment modality for choledocholithiasis. The advantages of this technique are that it is less invasive than conventional open surgery and it permits single-stage management; however, other technical difficulties limit its use. The aim of this article is to introduce our novel technique for LCBDE, which may overcome some of the limitations of conventional LCBDE.

Since December 2013, ten patients have undergone LCBDE using a V-shaped choledochotomy (V-CBD). After the confluence of the cystic duct and the CBD were exposed, a V-shaped incision was made along the medial wall of the cystic duct and the lateral wall of the common hepatic duct, which comprise two sides of Calot’s triangle. The choledochoscope was inserted into the lumen of the CBD through a V-shaped incision, and all CBD stones were retrieved using a basket or a Fogarty balloon catheter or were irrigated with saline. After CBD clearance was confirmed using the choledochoscope, the choledochotomy was closed with the bard absorbable suture material known as V-loc.

Results

The diameter of the CBD ranged from 8 to 30 mm, and the mean size of the stones was 11.6 ± 8.4 mm. The mean operative time was 97.8 ± 30.3 min, and the mean length of the postoperative hospital stay was 6.0 ± 4.6 days. All patients recovered without any postoperative complications, except for one patient who developed postoperative pancreatitis. No conversions to laparotomy were observed, and there were no recurrent stones and no need of T-tube insertion.

Conclusions

This report suggests that our novel technique, known as V-CBD, may represent a feasible and straightforward procedure for treating choledocholithiasis, especially when the CBD is not dilated.

【 授权许可】

   
2015 Kim et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]Huang SM, Wu CW, Chau GY, Jwo SC, Lui WY, P’eng FK. An alternative approach of choledocholithotomy via laparoscopic choledochotomy. Arch Surg. 1996; 131:407-11.
• [2]Cotton PB. Endoscopic management of bile duct stones; (apples and oranges). Gut. 1984; 25:587-97.
• [3]Paik KY, Kim EK. Laparoscopic common bile duct exploration after unsuccessful endoscopic stone removal. J Laparoendosc Adv Surg Tech A. 2013; 23:137-40.
• [4]Lu J, Xiong XZ, Cheng Y, Lin YX, Zhou RX, You Z et al.. One-stage versus two-stage management for concomitant gallbladder stones and common bile duct stones in patients with obstructive jaundice. Am Surg. 2013; 79:1142-8.
• [5]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.
• [6]Gu AD, Li XN, Guo KX, Ma ZT. Comparative evaluation of two laparoscopic procedures for treating common bile duct stones. Cell Biochem Biophys. 2011; 59:159-64.
• [7]Gurusamy KS, Samraj K. Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev. 2007;CD005640.
• [8]Sinha R. Laparoscopic choledocholithotomy with rigid nephroscope. J Laparoendosc Adv Surg Tech A. 2013; 23:211-5.
• [9]Bandyopadhyay SK, Khanna S, Sen B, Tantia O. Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration. J Minim Access Surg. 2007; 3:19-25.
• [10]El-Geidie AA. Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique? Surg Laparosc Endosc Percutan Tech. 2011; 21:282-7.
• [11]Huang SM, Yao CC, Cheng YW, Chen LY, Pan H, Hsiao KM et al.. Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis. Am Surg. 2010; 76:517-21.