Abstract
To explore whether transcystic-laparoscopic common bile duct exploration with microincision of the cystic duct and its confluence partis effective and safe as transductal-laparoscopic common bile duct exploration for the failed transcystic-laparoscopic common bile duct exploration in patients with choledocholithiasis. In this retrospective cohort study, we assigned patients with cholecystocholedocholithiasis to undergo transcystic-laparoscopic common bile duct exploration and laparoscopic cholecystectomy. The clinical outcomes of one-to-one propensity-matched pairs of transcystic-laparoscopic common bile duct exploration with microincision and transductal-laparoscopic common bile duct exploration groups were compared. Of 1650 patients with confirmed choledocholithiasis attempted transcystic-laparoscopic common bile duct exploration, transcystic-laparoscopic common bile duct exploration with microincision was done successfully in 128 patients (7.8%) and transductal-laparoscopic common bile duct exploration in 69 patients (4.2%). By one-to-one propensity score matching, 68 pairs were selected. There was no significant difference in in-hospital complication rate: 8.8% in transcystic-laparoscopic common bile duct exploration with the microincision group and 11.8% in the transductal-laparoscopic common bile duct exploration group (P = 0.573). The duration of operation in transcystic-laparoscopic common bile duct exploration with microincision was a little shorter than that in transductal-laparoscopic common bile duct exploration: median 125 (interquartile range 95–173) versus 150 (120–195) min, respectively (P = 0.003). Postoperative recovery was faster in transcystic-laparoscopic common bile duct exploration with microincision than in transductal-laparoscopic common bile duct exploration, as reflected by a shorter postoperative hospital stay (median 3 versus 5 days, P = 0.002, respectively). There was also no significant difference in rates of retained stone and recurrence of common bile duct stone between the groups. Transcystic-laparoscopic common bile duct exploration with microincision is as effective and safe as transductal-laparoscopic common bile duct exploration in patients with failed transcystic-laparoscopic common bile duct exploration.
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Reference
Phillips EH, Toouli J, Pitt HA, Soper NJ (2008) Treatment of common bile duct stones discovered during cholecystectomy. J Gastrointest Surg 12:624–628. https://doi.org/10.1007/s11605-007-0452-0
Rojas-Ortega S, Arizpe-Bravo D, López ERM, Cesin-Sánchez R, Reed-San Roman G, Gómez C (2003) Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointest Surg 7:492–496. https://doi.org/10.1016/s1091-255x(03)00026-x
Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441-445. https://doi.org/10.1007/s00464-006-0029-0
Tinoco R, Tinoco A, El-Kadre L, Peres L, Sueth D (2008) Laparoscopic common bile duct exploration. Ann Surg 247:674–679. https://doi.org/10.1097/SLA.0b013e3181612c85
Berthou J, Dron B, Charbonneau P, Moussalier K, Pellissier L (2007) Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc 21:1970–1974. https://doi.org/10.1007/s00464-007-9387-5
Chen XM, Zhang Y, Cai HH, Sun DL, Liu SY, Duan YF, Yang C, Jiang Y, Wu HR (2013) Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration. J Laparoendosc Adv Surg Tech A 23:977–981. https://doi.org/10.1089/lap.2013.0309
Varban O, Assimos D, Passman C, Westcott C (2010) Video. Laparoscopic common bile duct exploration and holmium laser lithotripsy: a novel approach to the management of common bile duct stones. Surg Endosc 24:1759–1764. https://doi.org/10.1007/s00464-009-0837-0
Petersson U, Johansen D, Montgomery A (2015) Laparoscopic transcystic laser lithotripsy for common bile duct stone clearance. Surgical laparoscopy, endoscopy & percutaneous techniques 25:33–36. https://doi.org/10.1097/SLE.0b013e31829cec5d
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. https://doi.org/10.1002/bjs.9922
Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Perretta S, Lezoche E (2007) Thirteen years’ experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc 21:34–40. https://doi.org/10.1007/s00464-005-0286-3
Topal B, Aerts R, Penninckx F (2007) Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc 21:2317–2321. https://doi.org/10.1007/s00464-007-9577-1
Zhu JG, Han W, Zhang ZT, Guo W, Liu W, Li J (2014) Short-term outcomes of laparoscopic transcystic common bile duct exploration with discharge less than 24 hours. Journal of laparoendoscopic & advanced surgical techniques Part A 24:302–305. https://doi.org/10.1089/lap.2013.0537
Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M, British Society of G (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57:1004–1021. https://doi.org/10.1136/gut.2007.121657
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. https://doi.org/10.1007/s00464-009-0809-4
Piraka C, Shah RJ, Awadallah NS, Langer DA, Chen YK (2007) Transpapillary cholangioscopy-directed lithotripsy in patients with difficult bile duct stones. Clin Gastroenterol Hepatol 5:1333–1338. https://doi.org/10.1016/j.cgh.2007.05.021
Cai H, Sun D, Sun Y, Bai J, Zhao H, Miao Y (2012) Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World journal of surgery 36:164–170. https://doi.org/10.1007/s00268-011-1346-6
Riciardi R, Islam S, Canete J, Arcand P, Stoker M (2003) Effectiveness and long–term results of laparoscopic common bile duct exploration. Surgical Endoscopy And Other Interventional Techniques 17:19–22. https://doi.org/10.1007/s00464-002-8925-4
Funding
This study is sponsored by the Beijing Municipal Administration of Hospitals Incubator Program (no. PX2019004), Beijing Talents Fund (2018000021469G197), Clinical technology innovation projects of Beijing hospitals authority (XMLX202102), and Capital Health Research and Special Development (no. 2016-1-1111).
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Wei Guo and Zhongtao Zhang: study conception and design; Jiegao Zhu, Wei Guo, and Wei Han: acquisition of data; Jiegao Zhu and Wei Han: analysis and interpretation of data; Jiegao Zhu, Wei Guo, and Wei Han: drafting of manuscript; Zhongtao Zhang and Wei Guo: critical revision of manuscript
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Zhu, J., Han, W., Zhang, Z. et al. Microincision of the Cyst Duct Is Safe and Effective for the Failed Laparoscopic Transcystic Common Bile Duct Exploration. Indian J Surg 84, 1263–1268 (2022). https://doi.org/10.1007/s12262-022-03304-8
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DOI: https://doi.org/10.1007/s12262-022-03304-8