Israel Abellán Morcillo1, Kamran Qurashi2, Jesús Abrisqueta Carrión3, Alberto Martinez Isla4. 1. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. Electronic address: israelabellanmorcillo@gmail.com. 2. Department of Surgery, Ealing Hospital, Londres, Reino Unido; FRCS (fellowship of the Royal College of Surgeons). 3. Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. 4. Department of Surgery, St. Mark's - Northwick Park hospital, Londres, Reino Unido; FRCS (fellowship of the Royal College of Surgeons).
Abstract
INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. AIMS: To present our experience and the lessons learned in more than 200 cases of LCBDE. PATIENTS AND METHODS: Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. RESULTS: The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. CONCLUSIONS: Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75.
INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. AIMS: To present our experience and the lessons learned in more than 200 cases of LCBDE. PATIENTS AND METHODS: Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. RESULTS: The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. CONCLUSIONS: Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75.
Authors: Mauro Podda; Francesco Maria Polignano; Andreas Luhmann; Michael Samuel James Wilson; Christoph Kulli; Iain Stephen Tait Journal: Surg Endosc Date: 2015-06-20 Impact factor: 4.584
Authors: Antonio Navarro-Sánchez; Hutan Ashrafian; Juan José Segura-Sampedro; Alberto Martrinez-Isla Journal: Surg Endosc Date: 2016-08-29 Impact factor: 4.584