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胃旁路术后患者微创胆总管结石管理:一次性支气管镜腹腔镜胆总管探查术。

Minimally Invasive Common Bile Duct Stone Management in Gastric Bypass Patients: Laparoscopic Common Bile Duct Exploration with Disposable Bronchoscope.

机构信息

Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Clinical Research Development Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

出版信息

Obes Surg. 2024 Jul;34(7):2553-2561. doi: 10.1007/s11695-024-07317-y. Epub 2024 Jun 1.


DOI:10.1007/s11695-024-07317-y
PMID:38822904
Abstract

BACKGROUND: Bariatric surgery patients may develop common bile duct stones, and the alterations in their anatomy present challenges in treating this condition. Methods such as laparoscopic bile duct exploration is impractical in many healthcare facilities, due to the absence of a choledochoscope. This study assesses the feasibility of laparoscopic exploration of the common bile duct using a disposable bronchoscope in these individuals. METHOD: The study involved 32 participants who had undergone gastric bypass surgery. These participants presented with both bile duct stones and bile ducts exceeding 8 mm in diameter, diagnosed through either MRCP or cholangiography conducted during the surgery. Stone extraction was carried out through either choledotomy or transcystic routes using a disposable bronchoscope and endoscopic baskets. RESULTS: The patients' ages ranged from 27 to 66 years, with a mean bile duct diameter of 11.6 mm (SD 3.1 mm). A 100% stone clearance rate was achieved for all patients. None of the patients required conversion to open surgery. No T-tubes were placed. One patient developed biloma and intra-abdominal abscesses, which were successfully treated with a percutaneous drain over the course of a week. No mortalities were recorded during the course of this study. CONCLUSION: Our study results demonstrate that laparoscopic bile duct exploration is both feasible and safe in patients who have undergone gastric bypass surgery. The utilization of a disposable bronchoscope emerges as a practical and cost-effective alternative to a choledochoscope in this procedure.

摘要

背景:减重手术患者可能会出现胆总管结石,其解剖结构的改变给治疗带来了挑战。由于缺乏胆管镜,许多医疗机构无法实施腹腔镜胆管探查术等方法。本研究评估了在这些患者中使用一次性支气管镜进行腹腔镜胆总管探查的可行性。

方法:该研究纳入了 32 名接受过胃旁路手术的参与者。这些参与者均经磁共振胰胆管成像(MRCP)或术中胆管造影术诊断为同时患有胆管结石和胆管直径超过 8mm。通过经胆囊管或经胆囊途径,使用一次性支气管镜和内镜篮,进行结石取出术。

结果:患者年龄 27-66 岁,平均胆管直径 11.6mm(SD 3.1mm)。所有患者的结石清除率均达到 100%。无患者需要转为开腹手术。未放置 T 型管。1 例患者发生胆漏和腹腔脓肿,经皮引流 1 周后成功治愈。本研究过程中无死亡病例。

结论:我们的研究结果表明,对于接受过胃旁路手术的患者,腹腔镜胆管探查术是可行且安全的。在该手术中,使用一次性支气管镜替代胆管镜具有实际意义且具有成本效益。

相似文献

[1]
Minimally Invasive Common Bile Duct Stone Management in Gastric Bypass Patients: Laparoscopic Common Bile Duct Exploration with Disposable Bronchoscope.

Obes Surg. 2024-7

[2]
Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis.

BMC Surg. 2020-3-17

[3]
Transcystic common bile duct exploration in the management of patients with choledocholithiasis.

J Gastrointest Surg. 2003

[4]
Single-step treatment of gall bladder and bile duct stones: a combined endoscopic-laparoscopic technique.

Int J Surg. 2009-8

[5]
Laparoscopic transcystic common bile duct exploration in patients with a nondilated common bile duct.

Ann Palliat Med. 2021-12

[6]
Laparoscopic Common Bile Duct Exploration Using a Disposable Bronchoscope.

Indian J Surg. 2022-12-15

[7]
Basket-in-catheter access for transcystic laparoscopic bile duct exploration: technique and results.

Surg Endosc. 2016-5

[8]
Laparoscopic common bile duct exploration: 15-year experience in a district general hospital.

Surg Endosc. 2016-6

[9]
[Exploration of biliary tracts for laparoscopy for treatment of choledocholithiasis].

Rev Gastroenterol Mex. 2004-11

[10]
Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration.

Chin Med J (Engl). 2012-10

本文引用的文献

[1]
Feasibility and safety of choledochotomy primary closure in laparoscopic common bile duct exploration without biliary drainage: a retrospective study.

Sci Rep. 2023-12-18

[2]
TAVAC: choledochoscopy disposable scopes, and the single-stage vs. two-stage approach to choledocholithiasis.

Surg Endosc. 2023-9

[3]
Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for patients with gallbladder and common bile duct stones a meta-analysis of randomized controlled trials.

Eur Rev Med Pharmacol Sci. 2023-5

[4]
Is There Any Other Alternative Instrument Rather Than a Choledoscope for Laparoscopic Common Bile Duct Exploration?

Obes Surg. 2023-6

[5]
Prevention of post-ERCP pancreatitis: current strategies and novel perspectives.

Therap Adv Gastroenterol. 2023-3-6

[6]
Incidence and risk factors for cholelithiasis after bariatric surgery: a systematic review and meta-analysis.

Lipids Health Dis. 2023-1-14

[7]
The feasibility of disposable video-bronchoscopes, Ambu aScope3, for exploration of the common bile duct and extraction of stones.

DEN Open. 2021-11-21

[8]
Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis.

Surg Endosc. 2022-9

[9]
Incidence of Symptomatic Cholelithiasis Following Laparoscopic Roux-en-Y Gastric Bypass Is Comparable to Laparoscopic Sleeve Gastrectomy: A Cohort Study.

Dig Dis Sci. 2022-8

[10]
3D Laparoscopic common bile duct exploration with primary repair by absorbable barbed suture is safe and feasible.

J Clin Transl Res. 2021-7-16

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