Abstract
Background
Detection of common bile duct (CBD) stones is a major objective of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC). We evaluated the feasibility and safety of the routine use of transcystic choledochoscopy following IOC (dual common bile duct examination: DCBDE), which may improve the diagnostic accuracy of CBD stones and facilitate one-stage clearance, in LC for suspected choledocholithiasis.
Methods
Between May 2017 and November 2018, 38 patients with suspected choledocholithiasis were prospectively enrolled in this study, regardless of whether they underwent endoscopic sphincterotomy. Transcystic choledochoscopy was routinely attempted following IOC in LC.
Results
Five cases were excluded due to cholecystitis, bile duct anomaly, or liver cirrhosis. DCBDE was performed in the remaining 33 patients. The biliary tree was delineated by IOC in all patients. Subsequently, choledochosope was performed in 32 patients except for one who was found to have pancreaticobiliary malunion in IOC. The scope was successfully passed into the CBD in 25 (78.1%) patients. Choledochoscopy detected 3 (9.4%) cases of cystic duct stones and 4 (12.5%) cases of CBD stones which were not identified by IOC. All those stones were removed via cystic duct. There were no intra- and postoperative complications, except for two cases of wound infection and one case of a transient increase in serum amylase.
Conclusions
DCBDE in LC is a safe and promising approach for intraoperative diagnosis and one-stage treatment of suspected choledocholithasis.
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References
ElGeidie AA (2014) Single-session minimally invasive management of common bile duct stones. World J Gastroenterol 20:15144–15152
Feng Q, Huang Y, Wang K, Yuan R, Xiong X, Wu L (2016) Laparoscopic transcystic common bile duct exploration: advantages over laparoscopic choledochotomy. PLoS ONE 11:e0162885
Zhu JG, Han W, Guo W, Su W, Bai ZG, Zhang ZT (2015) Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis. Br J Surg 102:1691–1697
Hamad MA, Nada AA, Abdel-Atty MY, Kawashti AS (2011) Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study. Surg Endosc 25:3747–3751
Pierce RA, Jonnalagadda S, Spitler JA, Tessier DJ, Liaw JM, Lall SC, Melman LM, Frisella MM, Todt LM, Brunt LM, Halpin VJ, Eagon JC, Edmundowicz SA, Matthews BD (2008) Incidence of residual choledocholithiasis detected by intraoperative cholangiography at the time of laparoscopic cholecystectomy in patients having undergone preoperative ERCP. Surg Endosc 22:2365–2372
Ueno K, Ajiki T, Sawa H, Matsumoto I, Fukumoto T, Ku Y (2012) Role of intraoperative cholangiography in patients whose biliary tree was evaluated preoperatively by magnetic resonance cholangiopancreatography. World J Surg 36:2661–2665
Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441–445
Vindal A, Chander J, Lal P, Mahendra B (2015) Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study. Surg Endosc 29:1030–1038
Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T (2020) A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 34:2904–2910
Gough V, Stephens N, Ahmed Z, Nassar AH (2012) Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value. Surg Endosc 26:3190–3194
Bansal VK, Misra MC, Rajan K, Kilambi R, Kumar S, Krishna A, Kumar A, Pandav CS, Subramaniam R, Arora MK, Garg PK (2014) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc 28:875–885
Ding G, Cai W, Qin M (2014) Single-stage vs. two-stage management for concomitant gallstones and common bile duct stones: a prospective randomized trial with long-term follow-up. J Gastrointest Surg 18:947–951
Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A (2013) Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 206:457–463
Mattila A, Mrena J, Kellokumpu I (2017) Cost-analysis and effectiveness of one-stage laparoscopic versus two-stage endolaparoscopic management of cholecystocholedocholithiasis: a retrospective cohort study. BMC Surg 17:79
Prasson P, Bai X, Zhang Q, Liang T (2016) One-stage laproendoscopic procedure versus two-stage procedure in the management for gallstone disease and biliary duct calculi: a systemic review and meta-analysis. Surg Endosc 30:3582–3590
Hanif F, Ahmed Z, Samie MA, Nassar AH (2010) Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc 24:1552–1556
Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D (2014) Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg 38:2403–2411
Otani T, Yokoyama N, Sato D, Kobayashi K, Iwaya A, Kuwabara S, Yamazaki T, Matsuzawa N, Saito H, Katayanagi N (2017) Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy. Asian J Endosc Surg 10:282–288
Lei J, Wang J, Li Q, Wu P, Yuan R, Zhu H, Zou S, Shao J, Fang L (2016) Laparoscopic Transcystic Common Bile Duct Exploration: T-Shaped Incision of Cystic Duct with FREDDY Laser Lithotripsy. J Laparoendosc Adv Surg Tech A 26:646–651
Collins C, Maguire D, Ireland A, Fitzgerald E, O'Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33
Lefemine V, Morgan RJ (2011) Spontaneous passage of common bile duct stones in jaundiced patients. Hepatobiliary Pancreat Dis Int 10:209–213
Choi YS, Do JH, Suh SW, Lee SE, Kang H, Park HJ (2017) Risk factors for the late development of common bile duct stones after laparoscopic cholecystectomy. Surg Endosc 31:4857–4862
Kim BS, Joo SH, Cho S, Han MS (2016) Who experiences endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy for symptomatic gallstone disease? Ann Surg Treat Res 90:309–314
Andrews S (2013) Gallstone size related to incidence of post cholecystectomy retained common bile duct stones. Int J Surg 11:319–321
Venneman NG, Buskens E, Besselink MG, Stads S, Go PM, Bosscha K, van Berge-Henegouwen GP, van Erpecum KJ (2005) Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy? Am J Gastroenterol 100:2540–2550
Diehl AK, Holleman DR Jr, Chapman JB, Schwesinger WH, Kurtin WE (1997) Gallstone size and risk of pancreatitis. Arch Intern Med 157:1674–1678
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T. Matsumura, S. Komatsu, K. Komaya, Y. Fukami, T. Arikawa, T. Saito, T. Osawa, S. Kurahashi, T. Uchino, S. Kato, Y. Toda, K. Kaneko and T. Sano have no conflict of interest to declare.
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Matsumura, T., Komatsu, S., Komaya, K. et al. Dual common bile duct examination with transcystic choledochoscopy and cholangiography in laparoscopic cholecystectomy for suspected choledocholithiasis: a prospective study. Surg Endosc 35, 3379–3386 (2021). https://doi.org/10.1007/s00464-020-07779-y
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DOI: https://doi.org/10.1007/s00464-020-07779-y