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Langenbeck's Archives of Surgery

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Open Access 01-12-2019 | Endoscopic Retrograde Cholangiopancreatography | Original Article

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Authors: Timothy Jones, Jasim Al Musawi, Lalin Navaratne, Alberto Martinez-Isla

Published in: Langenbeck's Archives of Surgery | Issue 8/2019

Abstract

Purpose

Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy.

Methods

Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction.

Results

One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III–IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively.

Conclusions

LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.

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Title: Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration
Authors: Timothy Jones
Jasim Al Musawi
Lalin Navaratne
Alberto Martinez-Isla
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Endoscopic Retrograde Cholangiopancreatography
Choledocholithiasis
Laser
Published in: Langenbeck's Archives of Surgery / Issue 8/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01845-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Holmium laser lithotripsy improves the rate of successful transcystic laparoscopic common bile duct exploration

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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