Department of Surgery, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Surg Endosc. 2023 May;37(5):3994-3999. doi: 10.1007/s00464-022-09571-6. Epub 2022 Sep 6.
Laparoscopic common bile duct exploration (LCBDE) at the time of cholecystectomy is an efficient pathway for management of choledocholithiasis. Performing this safely under one anesthetic offers advantages over a two-step process with cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP). Despite the proven efficacy of LCBDE, endoscopy continues to be predominantly utilized. Simplifying the intervention may drive LCBDE adoption. To this end, we refined a stepwise intraoperative pathway that utilizes over the wire balloon catheters to dilate the Sphincter of Oddi to facilitate stone passage into the duodenum. To determine the efficacy during the initial adoption phase on a general surgery service, we reviewed our experience with LCBDE balloon sphincteroplasty as part of this pathway.
We retrospectively reviewed the records of patients who underwent LCBDE with balloon sphincteroplasty at a single tertiary care center over a three-year period. Preoperative demographics, imaging/laboratory results, intra and postoperative outcomes were reviewed.
Choledocholithiasis was managed with transcystic balloon sphincteroplasty during LCBDE in 28 cases over a three-year period. The cohort included 16 women and 12 men with a mean age of 47 years (range = 19-89). Operative indications included cholecystitis (n = 11, 39%), choledocholithiasis (n = 13, 47%), cholelithiasis (n = 2, 7%), and gallstone pancreatitis (n = 2, 7%). The stones were successfully cleared by the balloon sphincteroplasty technique in 75% of the cases. The average fluoroscopy time during LCBDE was 338 s (± 214). The average operating room time was 173 min (± 35). Mean length of stay was 58 h (± 46). There were no intra- or postoperative complications.
Wire ready cholangiography followed by balloon sphincteroplasty with saline/contrast flush is a simple and safe way to clear the common bile duct. This technique is a gateway for further expansion and adoption of LCBDE.
在胆囊切除术中进行腹腔镜胆总管探查术（LCBDE）是治疗胆总管结石的有效途径。在一次麻醉下安全地进行手术比胆囊切除术和内镜逆行胰胆管造影术（ERCP）两步法更具优势。尽管 LCBDE 已被证明具有疗效，但内镜检查仍主要被采用。简化干预措施可能会推动 LCBDE 的采用。为此，我们改进了一种分步式术中途径，该途径使用经导丝的球囊导管扩张 Oddi 括约肌，以促进结石进入十二指肠。为了在普通外科服务中确定在初始采用阶段的疗效，我们回顾了我们在该途径中使用 LCBDE 球囊括约肌成形术的经验。
我们回顾性地审查了在一家三级护理中心接受 LCBDE 联合球囊括约肌成形术治疗的患者的记录，时间跨度为三年。审查了术前人口统计学资料、影像学/实验室结果、术中及术后结果。
在三年期间，LCBDE 联合球囊括约肌成形术共治疗了 28 例胆总管结石患者。该队列包括 16 名女性和 12 名男性，平均年龄为 47 岁（范围 19-89 岁）。手术指征包括胆囊炎（n=11，39%）、胆总管结石（n=13，47%）、胆石症（n=2，7%）和胆石性胰腺炎（n=2，7%）。在 75%的病例中，球囊括约肌成形术成功清除了结石。LCBDE 期间平均透视时间为 338 秒（±214 秒）。平均手术时间为 173 分钟（±35 分钟）。平均住院时间为 58 小时（±46 小时）。无术中或术后并发症。
经导丝胆管造影后行球囊括约肌成形术并用盐水/对比剂冲洗是一种简单而安全的清除胆总管的方法。这种技术是进一步扩展和采用 LCBDE 的途径。
