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LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure

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Abstract

Background

Laparoscopic bile duct exploration (LBDE) is recommended in current treatment guidelines for the management of choledocholithiasis with gallbladder in situ. Failure of this technique is common as a consequence of large or impacted common bile duct (CBD) stones. In this series, we present our experience in using holmium laser lithotripsy as an adjunct to LBDE for the treatment of choledocholithiasis.

Methods

Between 2014 and 2016, eighteen laparoscopic bile duct explorations utilising holmium laser lithotripsy were performed after failure of standard retrieval techniques.

Results

Choledocholithiasis was successfully treated in 18 patients using laparoscopic holmium laser lithotripsy (transcystically in 14 patients). There was one failure where a CBD stricture prevented the scope reaching the stone. Two medical complications were recorded (Clavien–Dindo I and II). There were no mortalities or re-interventions.

Conclusions

LABEL technique is a successful and safe method to enhance LBDE in cases of impacted or large stones. In our experience, this approach increases the feasibility of the transcystic stone retrieval and may reduce overall operative time.

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Author contribution

ANS, HA, JJSS and AI made substantial contributions to design, acquisition of data, analysis and interpretation of data. All authors participated in drafting the article and revising it critically for important intellectual content. All authors gave final approval of the version to be submitted.

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Authors and Affiliations

  1. Department of Upper GI Surgery, Northwick Park and St Mark’s Hospital, North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex, London, HA1 3UJ, UK

    Antonio Navarro-Sánchez, Hutan Ashrafian & Alberto Martrinez-Isla

  2. Hospital Universitario Insular de Gran Canaria, Avenida Marítima del Sur s/n, Las Palmas de Gran Canaria, 35016, Las Palmas, Spain

    Antonio Navarro-Sánchez

  3. The Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed Street, London, W2 1NY, UK

    Hutan Ashrafian

  4. Hospital Universitario Son Espases, Ctra. Valldemosa 79, 07120, Palma de Mallorca, Spain

    Juan José Segura-Sampedro

Authors
  1. Antonio Navarro-Sánchez
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  2. Hutan Ashrafian
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  3. Juan José Segura-Sampedro
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  4. Alberto Martrinez-Isla
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Corresponding author

Correspondence to Alberto Martrinez-Isla.

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Disclosure

Drs. Antonio Navarro-Sánchez, Hutan Ashrafian, Juan José Segura-Sampedro and Alberto Isla have no conflicts of interest or financial ties to disclose.

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Navarro-Sánchez, A., Ashrafian, H., Segura-Sampedro, J.J. et al. LABEL procedure: Laser-Assisted Bile duct Exploration by Laparoendoscopy for choledocholithiasis: improving surgical outcomes and reducing technical failure. Surg Endosc 31, 2103–2108 (2017). https://doi.org/10.1007/s00464-016-5206-1

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  • DOI: https://doi.org/10.1007/s00464-016-5206-1

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