Top

World Journal of Surgery

Published in:

01-06-2013

Laparoscopic Treatment for Unsuspected Common Bile Duct Stones by Transcystic Sphincter of Oddi Pneumatic Balloon Dilation and Pressure-Washing Technique

Authors: Luigi Masoni, Francesco Saverio Mari, Vincenzo Pietropaolo, Maurizio Onorato, Massimo Meucci, Antonio Brescia

Published in: World Journal of Surgery | Issue 6/2013

Abstract

Background

Unsuspected common bile duct stones (CBDS) are found in 4–5 % of patients with cholelithiasis. The optimal strategy for the treatment of asymptomatic CBDS, diagnosed during laparoscopic cholecystectomy (LC), is not yet well established. A one-stage solution is preferable to solve the CBDS during the LC and to avoid the exposure of patients to the risks of a second procedure, such as complications or failure.

Methods

We attempted to remove CBDS by transcystic sphincter of Oddi pneumatic balloon dilation and common bile duct pressure-washing in all cases of intraoperative identification of CBDS since September 2008.

Results

In 29 cases, unsuspected CBDS was identified by intraoperative cholangiography; in 28 cases a single stone with a mean diameter of 4.3 mm (range = 3–6) was detected and in one case three 5–8-mm-diameter stones were identified. Clearance of the common bile duct was obtained in 27 cases (96 %), with a mean operative time of 54 min (range = 36–90) and mean length of hospital stay of 2.5 days.

Conclusion

Treatment of unsuspected CBDS detected by intraoperative cholangiography during LC with this original technique was safe and effective and a viable alternative of the transcystic endoscopic approach.

Metcalfe MS, Ong T, Bruening MH et al (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187(4):475–481PubMedCrossRef

Snow LL, Weinstein LS, Hannon JK et al (2001) Evaluation of operative cholangiography in 2043 patients undergoing laparoscopic cholecystectomy: a case for the selective operative cholangiogram. Surg Endosc 15:14–20PubMedCrossRef

Memon MA, Hassaballa H, Memon MI (2000) Laparoscopic common bile duct exploration: the past, the present, and the future. Am J Surg 179(4):309–315PubMedCrossRef

Roush TS, Trasverso LW (1995) Management and long-term follow-up of patients with positive cholangiograms during laparoscopic cholecystectomy. Am J Surg 169:484–487PubMedCrossRef

Lezoche E, Paganini AM (1995) Single stage laparoscopic treatment of gallstones and common bile duct stones in 120 unselected, consecutive patients. Surg Endosc 9(10):1070–1075PubMedCrossRef

Caddy GR, Tham TC (2006) Symptoms, diagnosis and endoscopic management of common bile duct stones. Best Pract Res Clin Gastroenterol 20(6):1085–1101PubMedCrossRef

Romagnuolo J, Bardou M, Rahme E et al (2003) Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139(7):547–557PubMedCrossRef

Perry KA, Myers JA, Deziel DJ (2008) Laparoscopic ultrasound as the primary method for bile duct imaging during cholecystectomy. Surg Endosc 22(1):208–213PubMedCrossRef

Catheline JM, Turner R, Paries J (2002) Laparoscopic ultrasonography is a complement to cholangiography for the detection of choledocholithiasis at laparoscopic cholecystectomy. Br J Surg 89(10):1235–1239PubMedCrossRef

10.

Barteau JA, Castro D, Arregui ME et al (1995) A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy. Surg Endosc 9(5):490–496PubMedCrossRef

11.

Birth M, Ehlers KU, Delinikolas K et al (1998) Prospective randomized comparison of laparoscopic ultrasonography using a flexible-tip ultrasound probe and intraoperative dynamic cholangiography during laparoscopic cholecystectomy. Surg Endosc 12(1):30–36PubMedCrossRef

12.

Siperstein A, Pearl J, Macho J et al (1999) Comparison of laparoscopic ultrasonography and fluorocholangiography in 300 patients undergoing laparoscopic cholecystectomy. Surg Endosc 13(2):113–117PubMedCrossRef

13.

Hublet A, Dili A, Lemaire J et al (2009) Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study. Acta Chir Belg 109(3):312–316PubMed

14.

Cotton PB, Lehman G, Vennes J (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37(3):383–393PubMedCrossRef

15.

Freeman LM, Nelson DB, Sherman S (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335(13):909–918PubMedCrossRef

16.

Loperfido S, Angelini G, Benedetti G (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48(1):1–10PubMedCrossRef

17.

Martin IJ, Bailey S, Rhodes M et al (1998) Towards T-tube free laparoscopic bile duct exploration: a methodologic evolution during 300 consecutive procedures. Ann Surg 228(1):29–34PubMedCrossRef

18.

Tai CK, Tang CN, Ha JPY et al (2004) Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surg Endosc 18(6):910–914PubMedCrossRef

19.

Bergman JJ, van Berkel AM, Bruno MJ (2001) A randomized trial of endoscopic balloon dilatation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy. Gastrointest Endosc 53(1):19–26PubMedCrossRef

20.

Baron TH, Harewood GC (2004) Endoscopic balloon dilatation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a meta-analysis of randomized, controlled trials. Am J Gastroenterol 99(8):1455–1460PubMedCrossRef

21.

Park DH, Kim MH, Lee SK (2004) Endoscopic sphincterotomy vs. endoscopic papillary balloon dilatation for choledocholithiasis in patients with liver cirrhosis and coagulopathy. Gastrointest Endosc 60(2):80–85

22.

Yasuda I, Tomita E, Enya M et al (2001) Can endoscopic papillary balloon dilatation for choledocholithiasis really preserve sphincter of Oddi function? Gut 49(5):686–691PubMedCrossRef

23.

Weinberg BM, Shindy W, Lo S (2006) Endoscopic balloon sphincter dilatation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev 18(4):CD004890

24.

Rojas-Ortega S, Arizpe-Bravo D, Martin Lopez ER et al (2003) Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg 7(4):492–496PubMedCrossRef

25.

Thompson MH, Tranter SE (2002) All-comers policy for laparoscopic exploration of the common bile duct. Br J Surg 89(12):1608–1612PubMedCrossRef

26.

Topal E, Aerts R, Pennickx F (2007) Laparoscopic common bile duct clearance with flexible choledochoscopy. Surg Endosc 21(12):2317–2321PubMedCrossRef

27.

Dion YM, Ratelle R, Morin J et al (1994) Common bile duct exploration: the place of laparoscopic choledochotomy. Surg Laparosc Endosc 4(6):419–424PubMedCrossRef

28.

Christoforidis E, Konstantinos V, Konstantinos B et al (2008) Feasibility of therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones in nonagenarians: a single unit audit. J Gastrointest Liver Dis 17(4):427–432

29.

Cavina E, Franceschi M, Sidoti F et al (1998) Laparo-endoscopic “rendezvous”: a new technique in the choledocholithiasis treatment. Hepatogastroenterology 45(23):1430–1435PubMed

30.

Aroori S, Bell JC (2002) Laparoscopic management of common bile duct stones: our initial experience. Ulster Med J 71(1):22–25PubMed

31.

Shuchleib S, Chousleb A, Mondragon A et al (1999) Laparoscopic common bile duct exploration. World J Surg 23(7):698–701. doi:10.1007/PL00012371 PubMedCrossRef

32.

Kondylis PD, Simmons DR, Agarwal SK et al (1997) Abnormal intraoperative cholangiography. Treatment options and long term follow-up. Arch Surg 132:347–350PubMedCrossRef

33.

Chung RS, Klabbatz L, Chari V et al (1998) Unsuspected choledocholithiasis first diagnosed at laparoscopic cholecystectomy: treatment by trans-cystic duct stenting and elective stent-guided sphincterotomy. Gastrointest Endosc 48:71–74PubMedCrossRef

Title: Laparoscopic Treatment for Unsuspected Common Bile Duct Stones by Transcystic Sphincter of Oddi Pneumatic Balloon Dilation and Pressure-Washing Technique
Authors: Luigi Masoni
Francesco Saverio Mari
Vincenzo Pietropaolo
Maurizio Onorato
Massimo Meucci
Antonio Brescia
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 6/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-1992-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic Treatment for Unsuspected Common Bile Duct Stones by Transcystic Sphincter of Oddi Pneumatic Balloon Dilation and Pressure-Washing Technique

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2013

Management of Hemangioma of the Liver: Surgical Therapy or Observation?

Preoperative Carcinoembryonic Antigen Level Predicts Prognosis in Patients with Pseudomyxoma Peritonei Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

What Is Riskier for the Patient with an Asymptomatic Large Hepatic Hemangioma: Observation or the Surgeon?

Obstacles to Surgical Services in a Rural Cameroonian District Hospital

Early and Late Presentations of Graft Arterial Pseudoaneurysm Following Pancreatic Transplantation

Outcome of Patients with Aggressive Pseudomyxoma Peritonei Treated by Cytoreductive Surgery and Intraperitoneal Chemotherapy