Skip to main content
SpringerLink
Log in

Laparoscopic transcystic or transcholedochal choledochoscopy during common bile duct exploration for stones? Differences and similarities

  • Clinical Study
  • Published:
Hellenic Journal of Surgery

Abstract

Aim

To assess laparoscopic choledochoscopy and compare the results of two different routes of access for laparoscopic common bile duct exploration, namely the transcystic versus the transductal approach.

Material-Method

One hundred and sixty-eight (168) patients were subjected to laparoscopic choledochoscopy for exploration of the common bile duct (CBD) for stones. The patients were categorized into three groups: group A included 34 patients subjected to transcystic choledochoscopy with a 2 mm choledochoscope; group B comprised 112 patients submitted to transductal choledochoscopy through choledochotomy with a 4.5mm choledochoscope; and group C included 32 patients whose preoperative ERCP sphincterotomy was unsuccessful for various reasons. In both transcystic and transductal access, we measured the rate of entrance of the choledochoscope into the cystic duct (CD) and into the CBD, the rate of stone clearance from the CBD, of the view of the CBD proximally or distally, of passing the choledochoscope into the duodenum, the length of hospital stay, conversion of the method, and the rate of complications in the three groups. Finally, we determined the sensitivity and precision of the choledochoscopy. Two different types of choledochoscopes were used: the “Olympus CHF type CB 30L” for the transcystic method (2 mm) and the “Olympus CHF type P20Q” for the transductal route (4.5 mm).

Results

The rate of entrance of the choledochoscope through the cystic duct was 70.6% and through choledochotomy it reached 100%. CBD clearance was 91.66% in group A, 96.42% in group B and 96.87% in group C. The view of the distal CBD was 100% in both transcystic and transductal access, but the view of the proximal CBD was only 12.5% in the transcystic approach as opposed to 100% in the transductal approach (p<0.001). The rate of conversion of one procedure to another was 27.3%, 1.8% and 34.3% for groups A, B and C, respectively (p<0.001). The rate of passing the choledochoscope into the duodenum was 70.8% in group A and 31.2% in group B (p<0.025). Mean length of hospital stay was 2.25 days in group A, 5.15 days in group B and 12.4 days in group C (p<0.05). The complication rate was 4.16%. 6.25% and 18.75% in groups A, B and C, respectively. Finally, the sensitivity of choledochoscopy regarding the clearance of CBD was 100% for all groups and the precision was 91.66%, 96.42% and 96.87% in groups A, B and C, respectively.

Conclusion

Regardless of the route chosen, laparoscopic choledochoscopy is an extremely reliable method with very high sensitivity and precision as concerns the clearance of CBD stones, provided that the criteria of patient selection are strictly observed. In addition, its reproducibility in both transcystic or transductal routes establishes laparoscopic choledochoscopy as the gold standard procedure for common bile duct exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nahrwold D. The biliary system. In: Sabiston X, ed. Textbook of surgery. Philadelphia: WE Saunders, 1986.

    Google Scholar 

  2. Petelin JB. Laparoscopic common bile duct exploration: Lessons learned from >12 years experience. Surg Endosc 2003;17:1705–15.

    Article  CAS  PubMed  Google Scholar 

  3. Beal J. Historical perspective of gallstone disease. Surg Gynecol Obstet 1984;158:181–9.

    CAS  PubMed  Google Scholar 

  4. Fink AS. To ERCP or not to ERCP? That is the question. Surg Endosc 1993;7:375–6.

    Article  CAS  PubMed  Google Scholar 

  5. Cox MR, Wilson TG, Toouli J. Peroperative endoscopic sphincterotomy during laparoscopic cholecystectomy for choledocholithiasis. Br J Surg 1995;82:257–9.

    Article  CAS  PubMed  Google Scholar 

  6. Perissat J, Huibregtse K, Keane FV, Russell CG, Neoptolemos JP. Management of bile duct stones in the era of laparoscopic cholecystectomy. Br J Surg 1994;81:799–810.

    Article  CAS  PubMed  Google Scholar 

  7. Traverso LW. A cost-effective approach to the treatment of common bile duct stones with surgical versus endoscopic techniques. In Berci G, Cuschieri A (ed): Bile Ducts and Bile Duct Stones. Philadelphia, PA, WB Saunders; 1996. pp. 154–160.

    Google Scholar 

  8. Petelin J. Laparoscopic approach to common duct pathology. Surg Lap & Endosc 1991;1:33–41.

    CAS  Google Scholar 

  9. Hunter J. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992;163:53–8.

    Article  CAS  PubMed  Google Scholar 

  10. Carroll BJ, Phillips EH, Daykhovsky L, Grundfest WS, Gersham A, Fallas M, Chandra M. Laparoscopic choledochoscopy: an effective approach to the common duct. Journal of Laparoendoscopic Surgery 1992;2:15–21.

    Article  CAS  PubMed  Google Scholar 

  11. Sackier JM, Berci G, Pas-Partlow M. Laparoscopic transcystic choledochotomy as an adjunct to laparoscopic cholecystectomy. The American Surgeon 1991;57:323–6.

    CAS  PubMed  Google Scholar 

  12. Cuschieri A, Lezoche E, Morino M, et al. EAES multicenter prospective randomized trial comparing two stage vs singlestage management of patients with gallstone disease and ductal calculi. Surg Endosc 1999;13:952–7.

    Article  CAS  PubMed  Google Scholar 

  13. Jacobs M, VCerdeja JC, Goldstein HS. Laparoscopic choledocholithotomy. Jnl Laparoendoscopic Surgery 1991;1:2:79-82.

    Google Scholar 

  14. Quattlebaum JK, Flanders HD. Laparoscopic treatment of common bile duct stones. Surg Lap & Endosc 1991;1:26–32.

    Google Scholar 

  15. Appel S, Krebs H, Fern D. Techniques for laparoscopic cholangiography and removal of common duct stones. Surg Endosc 1992;6:134–7.

    Article  CAS  PubMed  Google Scholar 

  16. Escat J, Fourtanier G, Maigne C, Vaislic C, Fournier D, Prevost F. Choledochoscopy in common bile duct surgery for choledocholithiasis: a must. Am Surg 1985;51:166–7.

    CAS  PubMed  Google Scholar 

  17. Fink AS. Current dilemmas in management of common duct stones. Surg Endosc 1993;7:285–91.

    Article  CAS  PubMed  Google Scholar 

  18. Pappas TN, Slimane TB, Brooks DC. 100 consecutive common duct explorations without mortality. Ann Surg 1990;211:260–2.

    PubMed Central  CAS  PubMed  Google Scholar 

  19. Karaliotas C, Sgourakis G, Goumas C, Papaioannou N, Lilis C, Leandros E. Laparoscopic common bile duct exploration after failed endoscopic stone extraction. Surg Endosc 2008;22:1826–31.

    Article  PubMed  Google Scholar 

  20. Sgourakis G, Dedemadi G, Stamatelopoulos A, Leandros E, Voros D, Karaliotas C. Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 2005;11:3267–72.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Carroll BJ, Fallas MJ, Phillips EH. Laparoscopic transcystic choledochoscopy. Surg Endosc, 1994;8:310–4.

    Article  CAS  PubMed  Google Scholar 

  22. Petelin JB. Laparoscopic ductal stone clearance: transcystic approach. In: Berci G, Cuschieri A, eds. Bile Ducts and Bile Duct Stones. Philadelphia: WB Saunders; 1996. pp. 97–108.

    Google Scholar 

  23. Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol 2008;56:45–50.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Thornton JK. Observations on cases illustrating hepatic surgery. Lancet 1891;1:763.

    Article  Google Scholar 

  25. Bakes J. Die Choledochopapilloskopie, nebst bermerkungen uber hepaticus drainage und dilation per papillae. Arch Klin Chir 1923;126:473.

    Google Scholar 

  26. McIver MA. An instrument for visualing the interior of the common duct at operation. Surgery 1941;9:112–4.

    Google Scholar 

  27. Wildegans H. Endoskopie der Tiefen Gallenwege. Arch Klin Chir 1953;276:652–9.

    CAS  PubMed  Google Scholar 

  28. Shore JM, Lippman HN. A flexible choledochoscope. Lancet 1965;1:1200.

    CAS  PubMed  Google Scholar 

  29. Robinson SM, Al-Mukhtar AM, Nayar AM, White SA. The Use of a Mechanical Lithotripsy Device as an Adjunct to Common Bile Duct Exploration. Ann R Coll Surg Engl 2009;91:347–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Ashby BS. Operative choledochoscopy in common bile duct surgery. Annals of the Royal College of Surgeons of England 1985;67:279–83.

    PubMed Central  CAS  PubMed  Google Scholar 

  31. Sgourakis G, Lanitis S, Karaliotas C, Gockel I, Kaths M, Karaliotas C. Primär laparoskopische, einzeitige versus endoskopische Therapie der Choledocholithiasis Eine retrospektive Fall-Kontroll-Studie. Chirurg 2012; [jvn]:[afp]–[alp] DOI 10.1007/s00104-012-2279-9 © Springer-Verlag 2012.

    Google Scholar 

  32. Korontzi MI, Karaliotas Ch, Sgourakis G, Lanitis S, Karaliotas C. Choledochoscopy as a Diagnostic and Therapeutic Tool for Common Bile Duct Stones: Retrospective Clinical Study. Hellenic Journal of Surgery 2012;84:347–54.

    Article  Google Scholar 

  33. Cuendis-Velazquez A, Rojano-Rodriguez ME, Morales-Chavez CE, et al. Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones. Revista de Gastroenterologa de Mexico 2014;79:22–7.

    Article  CAS  Google Scholar 

  34. Todd Wood, Bruce V. MacFadyen JR. Diagnostic and Therapeutic Choledochoscopy. Semin Laparosc Surg 2000;7:288–94.

    Article  Google Scholar 

  35. Cheung MT, Wai SH, Kwok PC. Percutaneous transhepatic choledochoscopic removal of intrahepatic stones. Br J Surg 2003;90:1409–15.

    Article  PubMed  Google Scholar 

  36. Hieken TJ, Birkett DH. Postoperative T-tube tract choledochoscopy. Am J Surg 1992;163:28–31.

    Article  CAS  PubMed  Google Scholar 

  37. Miin-Fu Chen, Yi-Yin Jan. Biliary cutaneous stent insertion via T-tube tract by choledochoscopy. Gastrointestinal Endoscopy 2000;51:5577–9.

    Google Scholar 

  38. Raijman I. Choledochoscopy/Cholangioscopy. Gastrointestinal Endoscopy Clinics, 2013;23:237–49.

    Article  PubMed  Google Scholar 

  39. Menzies D, Motson RW. Operative common bile duct imaging by operative cholangiography and flexible choledochoscopy. Br J Surg 1992;79:815–7.

    Article  CAS  PubMed  Google Scholar 

  40. Motson W, Wetter LA. Operative choledochoscopy: Common bile duct exploration is incomplete without it. Br J Surg 1990;77:975–82.

    Article  CAS  PubMed  Google Scholar 

  41. Topal W, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surgical Endoscopy 2007;21:2317–21.

    Article  CAS  PubMed  Google Scholar 

  42. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various Techniques for the Surgical Treatment of Common Bile Duct Stones: A Meta Review. Gastroenterology Research and Practice 2009; Article ID 840208, 12 pages, 2009. doi:10.1155/2009/840208.

    Google Scholar 

  43. Clayton ESJ, Connor S, Alexakis N, Leandros E. Metaanalysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 2006;93:1185–91.

    Article  CAS  PubMed  Google Scholar 

  44. Poulose EW, Arbogast PG, Holzman MD. National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surgical Endoscopy 2006;20:186–90.

    Article  CAS  PubMed  Google Scholar 

  45. Tai CK, Tang CN, Ha JPY, Chau CH, Siu WT, Li MKW. Laparoscopic exploration of common bile duct in difficult choledocholithiasis. Surgical Endoscopy 2004;18:910–4.

    Article  CAS  PubMed  Google Scholar 

  46. Moss JP. Choledochoscopy model. Am J Surg 1982;143:374–6.

    Article  CAS  PubMed  Google Scholar 

  47. Brooks DC, Pappas TN. Intraoperative use of a 2-mm choledochoscope for the exploration of small bile ducts and the pancreatic duct. Im Surg 1991;57:216–8.

    CAS  Google Scholar 

  48. Siddique I, Galati J, Ankoma-Sey V, et al. The role of choledochoscopy in the diagnosis and management of biliary tract diseases. Gastrointest Endosc 1999;50:67–73.

    Article  CAS  PubMed  Google Scholar 

  49. Shaw MJ, Dorsher PJ, Vennes JA. Cystic duct anatomy: an endoscopic perspective. Am J Gastroenterol 1993;88:2102–6.

    CAS  PubMed  Google Scholar 

  50. Gough V, Stephens N, Ahmed Z, Nassar AH. Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value. Surg Endosc 2012;26:3190–4.

    Article  PubMed  Google Scholar 

  51. Williams TJ, Green J, Beckingham I, Parks R, Martin D, Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut 2008;57:1004–21.

    Article  CAS  PubMed  Google Scholar 

  52. Barteau JA, Castro D, Arregui ME, et al. A comparison of intraoperative ultrasound versus cholangiography in the evaluation of the common bile duct during laparoscopic cholecystectomy. Surg Endosc 1995;9:490–6.

    Article  CAS  PubMed  Google Scholar 

  53. Ohtani T, Kawai C, Shirai Y, et al. Intraoperative ultrasonography versus cholangiography during laparoscopic cholecystectomy: a prospective comparative study. J Am Coll Surg 1997;185:274–82.

    Article  CAS  PubMed  Google Scholar 

  54. Catheline J, Rizk N, Champault G. A comparison of laparoscopic ultrasound vs cholangiography in the evaluation of the biliary tree during laparoscopic cholecystectomy. Eur J Ultrasound 1999;10:1–9.

    Article  CAS  PubMed  Google Scholar 

  55. Tranter SE, Thompson MH. A prospective single-blinded controlled study comparing laparoscopic ultrasound of the common bile duct with operative cholangiography. Surg Endosc 2003;17:216–9.

    Article  CAS  PubMed  Google Scholar 

  56. Rojas-Ortega S, Arizpe-Bravo D, Marin Lopez ER, Cesin-Sanchez R, Roman GR-S, Gomez C. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. Journal of Gastrointestinal Surgery 2003;7:492–6.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  58. Takada T, Yasuda H, Uchiyama K, Hasegawa H, Shikata J. Choledochoscopy during biliary surgery for reducing the risk of overlooked stones. Surg Endosc 1991;5:192–5.

    Article  CAS  PubMed  Google Scholar 

  59. Schwarz J, Simsa J, Pazdírek F. Our experience with peroperative choledochoscopy. Rozhl Chir 2007;86:180–3.

    CAS  PubMed  Google Scholar 

  60. Petelin JB. Laparoscopic ductal stone clearance: transcystic approach. In: Berci G, Cuschieri A, eds. Bile Ducts and Bile Duct Stones. Philadelphia: WB Saunders; 1996. pp. 97–108.

    Google Scholar 

  61. Rattner WD, Warshaw AL. Impact of choledochoscopy on the management of choledocholithiasis. Ann Surg 1981;194:76–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Surgical Department and Surgical Oncology Unit, Red Cross Hospital “Korgialeneio-Benakeio”, Athens, Greece

    C. Karaliotas, G. Sgourakis, S. Lanitis, A. Kouloura, K. Karkoulias & P. Brontzakis

  2. Reumatology, Physical Medicine and Rehabilitation Clinic of VFN, University Hospital, Prague, Czech Republic

    Ch. Karaliotas

Authors
  1. C. Karaliotas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Sgourakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Lanitis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kouloura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Karkoulias
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ch. Karaliotas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Brontzakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Karaliotas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karaliotas, C., Sgourakis, G., Lanitis, S. et al. Laparoscopic transcystic or transcholedochal choledochoscopy during common bile duct exploration for stones? Differences and similarities. Hellenic J Surg 87, 394–406 (2015). https://doi.org/10.1007/s13126-015-0246-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-015-0246-x

Keywords

Search

Navigation