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Surgical Endoscopy

, Volume 22, Issue 8, pp 1826–1831 | Cite as

Laparoscopic common bile duct exploration after failed endoscopic stone extraction

  • Constantine Karaliotas
  • George Sgourakis
  • Constantine Goumas
  • Nickolaos Papaioannou
  • Constantine Lilis
  • Emmanouel Leandros
Article

Abstract

Background

Our objective was to present the technical aspects and results of laparoscopic common bile duct (CBD) exploration following failed endoscopic stone extraction.

Method

From April 1997 to December 2006, 32 patients were referred to us after unsuccessful attempts at endoscopic CBD stone extraction. Transcholedochal laparoscopic CBD exploration was used in all patients. Previous operations, several pathologic entities, and stone impaction were studied as potential predictors of failure of the laparoscopic approach.

Results

Previous operations, cholangitis, anatomic abnormalities, and stone impaction were the principal reasons for failure of endoscopic retrograde cholangiopancreatography (ERCP). Stone extraction under direct laparoscopic choledochotomy was achieved in 20 of 31 patients (64.51%). Biliary stents were inserted in 7 patients (21.8%) and T tubes were placed in 21 patients (65.6%). Five laparoscopic choledochoduodenostomies were performed. There were 11 conversions to open surgery. Morbidity was 12.5%.

Conclusions

Laparoscopic choledochotomy is an efficacious procedure in dealing with unsuccessful endoscopic CBD clearance.

Keywords

Choledocholithiasis Endoscopic stone extraction Laparoscopic CBD exploration Laparoscopic choledochotomy 

Abbreviations

CBD

common bile duct

LC

laparoscopic cholecystectomy

ERCP

endoscopic retrograde cholangiopancreatography

ES

endoscopic sphincterotomy

PTBD

percutaneous transhepatic biliary drainage

References

  1. 1.
    McCune WS, Shorb PE, Moscowitz H (1968) Endoscopic cannulation of the ampulla of Vater: A preliminary report. Ann Surg 167:752–756PubMedCrossRefGoogle Scholar
  2. 2.
    American Society for Gastrointestinal Endoscopy (1989) Appropriate Use of Gastrointestinal Endoscopy. American Society for Gastrointestinal Endoscopy, Baltimore, MDGoogle Scholar
  3. 3.
    Classen M, Demling L (1974) Endoskopische Spjinkterotomie der papilla Vateri und Steinentraktion aus dem Ductus Choledochus. Dtsch Med Wochenschr 99:496–497PubMedCrossRefGoogle Scholar
  4. 4.
    Kawai K, Akasaka Y, Nurakami K, Tada M, Koli Y (1974) Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest Endosc 20:148–150PubMedCrossRefGoogle Scholar
  5. 5.
    Cotton PB (1984) Endoscopic management of bile duct stones (apples or oranges). Gut 25:587–597PubMedCrossRefGoogle Scholar
  6. 6.
    Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957PubMedCrossRefGoogle Scholar
  7. 7.
    Berci G, Morgenstern L (1994) Laparoscopic management of common bile duct stones: a multi-institutional Society of American Gastrointestinal Endoscopic Surgeons (SAGES) study. Surg Endosc 8:1168PubMedCrossRefGoogle Scholar
  8. 8.
    Sgourakis G, Karaliotas C (2002) Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chirurg 57:467–474Google Scholar
  9. 9.
    Sgourakis G, Dedemadi G, Stamatelopoulos A, Leandros E, Voros D, Karaliotas C (2005) Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 11(21):3171–3330Google Scholar
  10. 10.
    Shakoor T, Geenen JE (1992) Pre-cut papillotomy. Gastrointest Endosc 38:623–627PubMedGoogle Scholar
  11. 11.
    Catalano MF, Linder JD, Geenen JE (2004) Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: comparison with standard pre-cut papillotomy. Gastrointest Endosc 60:557–561PubMedCrossRefGoogle Scholar
  12. 12.
    Goldberg E, Titus M, Haluszka O, Darwin P (2005) Pancreatic-duct stent placement facilitates difficult common bile duct cannulation. Gastrointest Endosc 62:592–596PubMedCrossRefGoogle Scholar
  13. 13.
    Siegel JH, Ben-Zvi JS, Pullano W (1989) The needle knife: a valuable tool in diagnostic and therapeutic ERCP. Gastrointest Endosc 35:499–503PubMedGoogle Scholar
  14. 14.
    Bergman JJGHM, Rauws EAJ, Tijssen JGP, Tytgat GN, Huibregtse K (1995) Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc 42:195–201PubMedCrossRefGoogle Scholar
  15. 15.
    Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161PubMedCrossRefGoogle Scholar
  16. 16.
    Faylona JM, Qadir A, Chan AC, Lau J Y, Chung SC (1999) Small bowel perforations related to endoscopic retrograde cholangiopancreatography (ERCP) in patients with Billroth II gastrectomy. Endoscopy 31:546–549PubMedCrossRefGoogle Scholar
  17. 17.
    Lin LF, Siauw CP, Ho KS, Tung JC (1999) ERCP in post-Billroth II gastrectomy patients: emphasis on technique. Am J Gastroenterol 94:144–148PubMedCrossRefGoogle Scholar
  18. 18.
    Simmons TC (1991) Distal common bile duct stricture and secondary biliary cirrhosis due to choledocholithiasis. J Natl Med Assoc 3:1105–1108Google Scholar
  19. 19.
    Sugiyama M, Suzuki Y, Abe N, Masaki T, Mori T, Atomi Y (2004) Endoscopic retreatment of recurrent choledocholithiasis after sphincterotomy. Gut 53:1856–1859PubMedCrossRefGoogle Scholar
  20. 20.
    Johnson LW, Sehon JK, Lee WC, Zibari GB, McDonald JC (2001) Mirizzi’s syndrome: experience from a multi-institutional review. Am Surg 67:11–14PubMedGoogle Scholar
  21. 21.
    England RE, Martin DF (1997) Endoscopic management of Mirizzi syndrome. Gut 40:272–276PubMedGoogle Scholar
  22. 22.
    Lai EC, Mok FP, Tan ES, Lo CM, Fan ST, You KT, Wong J (1992) Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 326:1582–1586PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Constantine Karaliotas
    • 1
  • George Sgourakis
    • 1
  • Constantine Goumas
    • 2
  • Nickolaos Papaioannou
    • 1
  • Constantine Lilis
    • 1
  • Emmanouel Leandros
    • 3
  1. 1.2nd Surgical Department of Korgialenion – BenakionRed Cross HospitalAthensGreece
  2. 2.Department of Gastroenterology of Korgialenion – BenakionRed Cross HospitalAthensGreece
  3. 3.1st Propaedeutic Surgical Department of National Kappodistrian UniversityHippocration HospitalAthensGreece

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