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. 2019 May 31:43:52-63.
doi: 10.1016/j.amsu.2019.05.007. eCollection 2019 Jul.

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Emad Hamdy Gad  1 , Hazem Zakaria  1 , Yasmin Kamel  2 , Ayman Alsebaey  3 , Talat Zakareya  3 , Mohamed Abbasy  3 , Anwar Mohamed  3 , Ali Nada  3 , Mohammed Alsayed Abdelsamee  4 , Mohamed Housseni  4
Affiliations

Surgical (Open and laparoscopic) management of large difficult CBD stones after different sessions of endoscopic failure: A retrospective cohort study

Emad Hamdy Gad et al. Ann Med Surg (Lond). .

Abstract

Objectives: For complicated common bile duct stones (CBDS) that cannot be extracted by endoscopic retrograde cholangiopancreatography (ERCP), management can be safely by open or laparoscopic CBD exploration (CBDE). The study aimed to assess these surgical procedures after endoscopic failure.

Methods: We analyzed 85 patients underwent surgical management of difficult CBDS after ERCP failure, in the period from 2013 to 2018.

Results: Sixty-seven (78.8%) and 18(21.2%) of our patients underwent single and multiple ERCP sessions respectively. An impacted large stone was the most frequent cause of ERCP failure (60%). Laparoscopic CBDE(LCBDE), open CBDE(OCBDE) and the converted cases were 24.7% (n = 21), 70.6% (n = 60), and 4.7% (n = 4) respectively. Stone clearance rate post LCBDE and OCBDE reached 95.2% and 95% respectively, Eleven (12.9%) of our patients had postoperative complications without mortality. By comparing LCBDE and OCBDE; there was a significant association between the former and longer operative time. On comparing, T-tube and 1ry CBD closure in both OCBDE and LCBDE, there was significantly longer operative time, and post-operative hospital stays in the former. Furthermore, in OCBDE group, choledocoscopy had an independent direction to 1ry CBD repair and significant association with higher stone clearance rate, shorter operative time, and post-operative hospital stay.

Conclusion: Large difficult CBDS can be managed either by open surgery or laparoscopically with acceptable comparable outcomes with no need for multiple ERCP sessions due to their related morbidities; furthermore, Open choledocoscopy has a good impact on stone clearance rate with direction towards doing primary repair that is better than T-tube regarding operative time and post-operative hospital stay.

Keywords: CBD stones; Laparoscopic CBDE; Open CBDE.

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Figures

Fig. 1
Fig. 1
A: Laparoscopic cholecodoscopic view of CBD stone, B: laparoscopic cholecodoscopic stone extraction, C: laparoscopic primary closure of CBD.
Fig. 2
Fig. 2
(a,b) laparoscopic stone and stent extraction, ©: laparoscopic HJ.
Fig. 3
Fig. 3
a: OCBD extraction of stent and stone. b: Open primary closure of CBD.
Fig. 4
Fig. 4
a, b, OCBD extraction of stent and stones. c,d: Open T-tube insertion, and T-tube cholangiogram.
Fig. 5
Fig. 5
a: A cholecodoscopic view of stone in RT hepatic duct. b: Open cholecodoscopic basket extraction.
Fig. 6
Fig. 6
a: An open cholecodocoscopic view of stone and stent in distal CBD, b,c: cholecodoscopic extraction of stent and stone with duodenal mucosa appearance.
See this image and copyright information in PMC

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