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PubMed1995

[Laparoscopic treatment of common bile duct calculi].

Laparoscopic exploration of the common bile duct is now technically possible. This prospective study evaluates the feasibility of the different techniques and their complications. From January 1990 to March 1995, 140 patients, aged from 22 to 92, underwent laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 70 patients and was successful in 46 (65.7%). The failures were treated by 19 laparoscopic choledochotomies and 5 postoperative endoscopic sphincterotomies. A choledochotomy was performed in 89 cases and was successful in 85 (94.4%). The failures were treated by 3 laparotomies and 2 postoperative endoscopic sphincterotomy. The total success rate was 92.8% (130/140). The 5 local complications were pain (1), liver injury (1), and wound abscess (2), bleeding from a trocar site. Heart failure (medical treatment) (2), gastrointestinal haemorrhage from intestinal angiomas, severe pancreatitis after transcystic failure and psychiatric disorders were the 5 general complications. The total morbidity rate was 7.1%. There were 2 residual common bile duct stones. The mortality rate was 0. Mean hospital stay was 7.8 days. Laparoscopic exploration of the common bile duct appears to be safe and effective and should be included in the management protocol of choledocholithiasis.

Adult↗
PubMedDate not supplied

Carcinoid tmour of the common bile duct: report of a case and a review of the literature.

Carcinoid tumours of the common bile duct are extremely rare lesions. In this article we report a case with an extrahepatic bile duct carcinoid tumour. A 40-year-old woman suffered from biliary colic and jaundice. Pre-operative computed tomography demonstrated a tumour in the biliary tract. At laparotomy there was a tumour invading the common bile duct. Common bile duct resection was performed. Carcinoid tumour of the common bile duct was diagnosed histopathologically. For extrahepatic bile duct carcinoid tumours surgical resection is the only treatment modality that offers a chance to provide a cure and prolonged disease-free survival. The favourable histopathological and biological features of these tumours encouraged the surgeons to use more aggressive approaches for advanced disease.

Adenocarcinoma↗
PubMed1997

Transcystic biliary decompression after direct laparoscopic exploration of the common bile duct.

BACKGROUND: A purpose-designed transcystic common bile duct (CBD) decompression cannula is described for use as an alternative to T-tube insertion following laparoscopic direct CBD exploration. This permits safe primary closure of the choledochotomy. METHODS: Following direct supraduodenal laparoscopic clearance of large common bile duct stones, the biliary decompression cannula is inserted percutaneously inside its peel-away sheet over a guide-wire into the CBD via the cystic duct. When in place, the cannula is secured to the cystic duct by two catgut extracorporeal Roeder knots and the choledochotomy is then closed. The terminal multiperforated S-shaped segment of the Cuschieri biliary decompression cannula prevents postoperative dislodgement. RESULTS: Transcystic decompression of the extrahepatic biliary tract using the Cuschieri cannula has been used in 12 patients who underwent laparoscopic supraduodenal CBD exploration for large or occluding stones. There was no instance of postoperative dislodgement of the cannula and all patients had effective drainage of the common bile duct (average 300 ml bile per 24 h). The procedure was uncomplicated in all but one patient who developed self-limiting leakage from the CBD suture line in the early postoperative period. The median hospital stay after surgery was 4 days, with a range of 3 to 10 days. The cystic duct decompression cannula was capped and sealed under an occlusive dressing at the time of discharge. Removal of the cannula was carried out without any complications as a day case 11-16 days after surgery. CONCLUSIONS: Transcystic biliary decompression is safe and effective. The experience with is use indicates that compared to T-tube drainage, transcystic decompression may accelerate recovery and reduce the hospital stay in patients following laparoscopic direct exploration of the CBD. Its insertion is less technically demanding than placing a T-tube through the choledochotomy. Transcystic decompression with complete primary closure of the CBD realizes the full benefits of the single-stage management of common bile duct calculi and permits confirmation of complete stone clearance after surgery.

Aged↗
PubMed2000

Structure and composition of common bile duct stones in relation to duodenal diverticula, gastric resection, cholecystectomy and infection.

BACKGROUND: Common bile duct stones represent a clinical problem often involving severe infection, cholangitis and cholestasis. Stasis and infection are thought to play a part in the pathogenesis of choledocholithiasis. Investigations on the etiology of common bile duct stones are, however, scarce because of the difficult access to common bile duct stones and bile. In a clinical series of common bile duct stones, we studied the gross appearance of stones extracted endoscopically from the common bile duct and measured the cholesterol and bilirubinate content in order to elucidate factors of importance to etiology. METHODS: In 135 patients treated endoscopically for bile duct stones, the stones or parts of the stones were collected. Appearances of the cut surface of the stones were studied and described. Cholesterol and bilirubinate content were analyzed enzymatically and with infrared spectroscopy. The growth in bile of gas-producing bacteria previously shown to be correlated with enterobacteriacea was investigated. RESULTS: Seventy-five percent of the stones were pigment stones, the majority with concentric pigmented layering. There was good agreement between cholesterol measurements. With a cutoff at 50% for the infrared measurements and 25% for the enzymatic assay only 3 stones were discordant between cholesterol measurements and visual inspection. Twenty-one of 23 patients with a previous Billroth-II gastric resection had pigment stones (p < 0.05). Gas-producing bacteria were significantly more prevalent in the bile from patients with layered pigment stones. CONCLUSION: Pigment stones with concentric layering highly suggestive of a cyclic process of crystallization were recovered from the common bile duct in 70% of the patients in our series.

Adult↗
PubMedDate not supplied

Transcystic common bile duct exploration in the management of patients with choledocholithiasis.

Common bile duct stones are found in approximately 16% of patients undergoing laparoscopic cholecystectomy. If the diagnosis of choledocholithiasis is made at the preoperative workup, it is common practice to refer the patient for endoscopic retrograde cholangiography and endoscopic sphincterotomy. However, if the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma-that is, the choice between laparoscopic common bile duct exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy. We have opted to treat patients with choledocholithiasis in only one session during the laparoscopic cholecystectomy; we use the transcystic common bile duct exploration technique employing the choledochoscope. We report our early experience in terms of success of stone removal, operative time, morbidity and mortality, and length of hospital stay. From 1992 to 2002, we performed 350 laparoscopic cholecystectomies. Selective cholangiography was used in 105 patients (30%); 40 of them were found to have common bile duct stones, for an incidence of 11.4%. Among this group, we performed laparoscopic transcystic common bile duct exploration in all but six patients. Our success rate for stone removal was 94.1% (32 of 34 patients), with only two failures related to multiple stones and impaction at the ampulla, for a conversion rate of 5.8%. The mean operative time was 120+/-40 minutes. The morbidity rate was 8.8%, and there were no deaths. Length of hospital stay was 24 to 48 hours. Mean recovery time was 7 days, and time to return to work was 15+/-3 days. We concluded that most of the patients with common bile duct stones found during laparoscopic cholecystectomy could be treated successfully by means of the transcystic technique with choledochoscopy, with no increase in morbidity or mortality and a shortened hospital stay and recovery time, similar to patients who undergo only laparoscopic cholecystectomy. On the basis of our results, we recommend that this method become the primary strategy in the great majority of patients with common bile duct stones found during intraoperative cholangiography.

Adolescent↗
PubMed1992

[One hundred and twenty-five consecutive choledochotomies for suspected lithiasis without mortality. Current state of complications from common bile duct surgery].

The postoperative courses of 125 consecutive surgical common bile duct explorations performed between 1983 and 1990 were analysed. All cases of common bile duct lithiasis, but three, were operated on. Intraoperative cholangiography was performed in 98 percent and cholangioscopy in 92 percent of patients; common bile duct stones were found in 95 patients (76 percent); the common bile duct was sutured without drainage in 78 patients (58 percent). There were no deaths. Morbidity was 14 percent, of which 10 percent were serious. Four percent of common bile ducts retained stones. The specific morbidity was 4 percent. These results confirm the reliability of surgical management of common bile duct stones and therefore should be considered for the evaluation of new procedures, such as laparoscopic treatment of common duct stones, or combined laparoscopic cholecystectomy and endoscopic sphincterotomy.

Aged↗
PubMedDate not supplied

Adenomyoma of the common bile duct.

An unusual case of adenomyoma of the common bile duct is reported. A 31 year-old woman with intermittent epigastralgia was found to have cholestasis and stenosis of the common bile duct. A malignant tumor could not be excluded. Resection of the common bile duct with the tumor was performed with choledochojejunostomy reconstruction. The tumor consisted of glandular hyperplasia and proliferation of smooth muscle fibers and fibrous connective tissue. The patient was well at the 30-month follow-up. Although the benign tumors of the extrahepatic bile ducts are rare, the clinical importance lies in the recognition that they can cause biliary tract obstruction. Intra-operative frozen section for histologic examination is required to make the diagnosis and plan the surgical procedure. Complete extirpation of the lesion is recommended. A radical operation is not necessary.

Adenomyoma↗
PubMed1979

Surgical significance of the histopathology of the common bile duct.

Silver biopsies of the common bile duct were obtained from 15 patients with clinical and surgical evidence of cholangitis. The most pronounced histologic changes were edema, congestion, and marked mucous gland hypertrophy and hyperplasia. No ulceration, intramural abscess, or areas of necrosis were found. Clinical cholangitis is not associated with necrotizing changes in the duct wall. This fact is the histologic basis for satisfactory healing of choledochal enteric anastomoses performed in the presence of cholangitis.

Adult↗
PubMed1976

Retained common bile duct calculi.

A method of elimination of gallstones remaining in the common bile duct after exploration of the duct is described. The retained stone is flushed through the common duct sphincter into the duodenum using rapid infusion of normal saline via a T tube. The method is quick and simple and is recommended as the first step to take in the management of this discomforting group of patients. The method is not without potential morbidity and should only be carried out under carefully controlled conditions.

Adult↗
PubMed1983

Percutaneous cholecystostomy for entry into the canine gallbladder and common bile duct.

Interventional postoperative manipulation of the common bile duct is usually performed for removal of retained calculi via T-tube or surgical cholecystostomy tracks. The removal of foreign bodies from the gallbladder and common bile duct in dogs via cholecystostomy tracks using interventional radiology techniques is described as an alternative to surgery.

Animals↗