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Surgical Endoscopy

, Volume 32, Issue 1, pp 485–497 | Cite as

Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches

  • Shu-Hung Chuang
  • Min-Chang Hung
  • Shih-Wei Huang
  • Dev-Aur ChouEmail author
  • Hurng-Sheng Wu
Dynamic Manuscript

Abstract

Background

Laparoscopic surgery for choledocholithiasis is still evolving. Only a few reports of single-incision laparoscopic common bile duct exploration (LCBDE) have been published.

Methods

One hundred and one consecutive patients underwent single-incision LCBDE (SILCBDE) by one surgeon with straight instruments during a 42-month period.

Results

Choledochotomies were performed on 61 patients (60.4%). The success rate of intrahepatic duct exploration was 68.0% (17/25) for patients undergoing transcystic choledochoscopic bile duct explorations following longitudinal cystic ductotomies. The ductal clearance rate was 100%. Eighteen procedures (17.8%) were converted, including one open surgery. Nineteen patients (18.8%) experienced 26 episodes of complications; the majority (19 episodes) were classified as Clavien–Dindo grade I. Excluding those patients with Mirizzi syndrome (McSherry type II), multivariate logistic regressions showed that patients who were older or had complicated cholecystitis had higher procedure conversion rates and that higher modified APACHE II scores, higher white blood cell counts, and longer operative times were independent risk factors for complications. Based on operative times, 20 successful SILCBDEs were needed to get through the learning phase. A higher transcystic approach rate (46.5 vs. 8.3%; P < 0.01) and a shorter operative time (207 ± 62 vs. 259 ± 66 min; P < 0.01) were observed in the experienced phase. Compared with our early series of multi-incision LCBDE, the SILCBDE group had a higher bile duct stone clearance rate (100 vs. 94.4%; P < 0.05) and a higher proportion of patients with concomitant acute cholecystitis (59.6 vs. 22.2%; P < 0.01).

Conclusions

LCBDE with a 100% ductal clearance rate is possible following an algorithm for various approaches. SILCBDE is feasible under a low threshold for procedure conversion. A transcystic approach should be tried first if indicated, and a longitudinal cystic ductotomy to the cystocholedochal junction is beneficial. Prospective, randomized trials comparing single-incision and multi-incision LCBDE are anticipated.

Keywords

Choledocholithiasis Choledochotomy Common bile duct exploration Laparoendoscopic single-site surgery Single-incision laparoscopic surgery Transcystic 

Notes

Acknowledgements

We gratefully acknowledge the work of Ms. Hsiu-Hung Huang in assisting with the data collection.

Compliance with ethical standards

Disclosures

Drs. Shu-Hung Chuang, Min-Chang Hung, Shih-Wei Huang, Dev-Aur Chou, and Hurng-Sheng Wu have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 81521 kb)

Supplementary material 2 (WMV 94092 kb)

Supplementary material 3 (WMV 57888 kb)

Supplementary material 4 (WMV 81576 kb)

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Shu-Hung Chuang
    • 1
    • 2
  • Min-Chang Hung
    • 1
    • 2
  • Shih-Wei Huang
    • 1
    • 2
  • Dev-Aur Chou
    • 1
    • 2
    Email author
  • Hurng-Sheng Wu
    • 1
    • 2
  1. 1.Division of General Surgery, Department of SurgeryShow Chwan Memorial HospitalChanghuaTaiwan
  2. 2.IRCAD-AITS Show Chwan Health Care SystemChanghuaTaiwan

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