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Surgical Endoscopy

, Volume 32, Issue 12, pp 4742–4748 | Cite as

Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies

  • L. Fang
  • J. Wang
  • W. C. Dai
  • B. Liang
  • H. M. Chen
  • X. W. Fu
  • B. B. Zheng
  • J. Lei
  • C. W. Huang
  • S. B. Zou
Article
  • 193 Downloads

Abstract

Background

LTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones.

Methods

To describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed.

Results

CBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3–8 mm, and 85 patients with cystic duct diameter ≥ 5 mm. The mean time for CBD stone extraction was 25.3 min, with the operative time ranged from 63 to 170 min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter ≥ 5 mm. Estimated blood loss during surgery was 10–120 ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3–7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months.

Conclusions

Based on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.

Keywords

Laparoscopic transcystic common bile duct exploration Cystic duct incision Laser lithotripsy Surgical strategy 

Notes

Acknowledgements

We would like to thank the contributions of all of the patients in our retrospective study. This work is supported by the Health Department of Jiangxi Province (Grant No.: 20131077), the Key Research Project of Jiangxi Province (Grant No.: 20171BBG70063), and Education Department of Jiangxi Province (Grant No.: GJJ150260).

Compliance with ethical standards

Disclosures

L. Fang, J. Wang, W. C. Dai, B. Liang, H. M. Chen, X. W. Fu, B. B. Zheng, J. Lei, C. W. Huang, and S. B. Zou have no conflicts of interest or financial ties to disclose.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hepatobiliary SurgeryThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
  2. 2.Department of Hepatobiliary SurgeryThe Third Affiliated Hospital of Nanchang UniversityNanchangChina
  3. 3.Department of General SurgeryYili Friendship HospitalYiliChina
  4. 4.Department of Hepatobiliary SurgeryThe People’s Hospital of JiangxiNanchangChina

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