Department of Surgical Gastroenterology and HPB Surgery, GEM Hospital and Research Center, 45/A, Pankaja Mill Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
Surg Endosc. 2018 Apr;32(4):1828-1833. doi: 10.1007/s00464-017-5868-3. Epub 2017 Oct 18.
Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is generally accepted as first line management for common bile duct (CBD) stones. CBD exploration, either by open or laparoscopic approach nowadays, is usually reserved for ERCP failures, complicated stone locations, along with altered anatomical situations. The aim of this study was to highlight the increasing role of laparoscopic choledochoduodenostomy which is not only a reliable but also as a rescue procedure for those failed ERCP cases due to complicated bile duct stones.
It is a retrospective review of the database, from a tertiary care teaching institution from India, from Jan 2012 up to December 2016.
Out of total 30 patients who underwent laparoscopic choledochoduodenostomy, 28 had failed ERC stone clearance while two patients were directly offered drainage in view of unfavorable anatomy. The major reasons for failed ERC stone clearance were as follows-multiple large calculi (42.8%), recurrent stones (21.4%), and associated stricture (21.4%). Mean operating time was 130 (± 27) minutes with mean blood loss of 60 (± 19) ml. Stone extraction was successful, primarily by milking in 13 (43.33%) patients, rest required augmentation by Dormia basket/balloon. Two patients (6.66%) developed controlled bile leak which resolved with conservative treatment. The median length of hospital stay was 5 days (IQR 3-9). Mean duration of follow-up was 17 (± 3.2) months.
Laparoscopic common bile duct exploration with choledochoduodenostomy has been shown to be a safe, reliable, and efficient method for treating complex CBDS, especially after failed ERCP procedures.
内镜逆行胰胆管造影术（ERCP）联合取石术通常被认为是治疗胆总管（CBD）结石的一线治疗方法。目前，CBD 探查术，无论是通过开放手术还是腹腔镜手术，通常保留用于 ERCP 失败、复杂结石位置以及解剖结构改变的情况。本研究旨在强调腹腔镜胆总管十二指肠吻合术的作用日益增加，它不仅是一种可靠的方法，也是治疗因复杂胆管结石而导致 ERCP 失败的患者的一种抢救方法。
这是对印度一家三级教学医院数据库的回顾性分析，时间从 2012 年 1 月至 2016 年 12 月。
在 30 例行腹腔镜胆总管十二指肠吻合术的患者中，28 例因 ERCP 未能清除结石而接受手术，另有 2 例因解剖结构不利而直接接受引流。ERCP 未能清除结石的主要原因如下：多发大结石（42.8%）、复发性结石（21.4%）和相关狭窄（21.4%）。平均手术时间为 130（±27）分钟，平均出血量为 60（±19）ml。13 例（43.33%）患者主要通过挤奶成功取出结石，其余患者需要通过 Dormia 篮/球囊来增强取石效果。2 例（6.66%）患者发生可控性胆漏，经保守治疗后得到缓解。中位住院时间为 5 天（IQR 3-9）。平均随访时间为 17（±3.2）个月。
腹腔镜胆总管探查术联合胆总管十二指肠吻合术已被证明是治疗复杂 CBDS 的一种安全、可靠且有效的方法，特别是在 ERCP 失败后。
