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

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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.

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences and Translational Medicine, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy

    Luigi Masoni, Francesco Saverio Mari, Massimo Meucci & Antonio Brescia

  2. Department of Gastroenterology and Endoscopy, School of Medicine and Dentistry, University Sapienza of Rome, Rome, Italy

    Vincenzo Pietropaolo & Maurizio Onorato

Authors
  1. Luigi Masoni
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  2. Francesco Saverio Mari
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  3. Vincenzo Pietropaolo
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  4. Maurizio Onorato
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  5. Massimo Meucci
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  6. Antonio Brescia
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Correspondence to Francesco Saverio Mari.

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Masoni, L., Mari, F.S., Pietropaolo, V. et al. Laparoscopic Treatment for Unsuspected Common Bile Duct Stones by Transcystic Sphincter of Oddi Pneumatic Balloon Dilation and Pressure-Washing Technique. World J Surg 37, 1258–1262 (2013). https://doi.org/10.1007/s00268-013-1992-y

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