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Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches.
Chuang, Shu-Hung; Hung, Min-Chang; Huang, Shih-Wei; Chou, Dev-Aur; Wu, Hurng-Sheng.
Afiliación
  • Chuang SH; Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan.
  • Hung MC; IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan.
  • Huang SW; Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan.
  • Chou DA; IRCAD-AITS Show Chwan Health Care System, Changhua, Taiwan.
  • Wu HS; Division of General Surgery, Department of Surgery, Show Chwan Memorial Hospital, 542, Sec 1 Chung-Shan Rd., Changhua, 500, Taiwan.
Surg Endosc ; 32(1): 485-497, 2018 01.
Article en En | MEDLINE | ID: mdl-28643057
ABSTRACT

BACKGROUND:

Laparoscopic surgery for choledocholithiasis is still evolving. Only a few reports of single-incision laparoscopic common bile duct exploration (LCBDE) have been published.

METHODS:

One hundred and one consecutive patients underwent single-incision LCBDE (SILCBDE) by one surgeon with straight instruments during a 42-month period.

RESULTS:

Choledochotomies were performed on 61 patients (60.4%). The success rate of intrahepatic duct exploration was 68.0% (17/25) for patients undergoing transcystic choledochoscopic bile duct explorations following longitudinal cystic ductotomies. The ductal clearance rate was 100%. Eighteen procedures (17.8%) were converted, including one open surgery. Nineteen patients (18.8%) experienced 26 episodes of complications; the majority (19 episodes) were classified as Clavien-Dindo grade I. Excluding those patients with Mirizzi syndrome (McSherry type II), multivariate logistic regressions showed that patients who were older or had complicated cholecystitis had higher procedure conversion rates and that higher modified APACHE II scores, higher white blood cell counts, and longer operative times were independent risk factors for complications. Based on operative times, 20 successful SILCBDEs were needed to get through the learning phase. A higher transcystic approach rate (46.5 vs. 8.3%; P < 0.01) and a shorter operative time (207 ± 62 vs. 259 ± 66 min; P < 0.01) were observed in the experienced phase. Compared with our early series of multi-incision LCBDE, the SILCBDE group had a higher bile duct stone clearance rate (100 vs. 94.4%; P < 0.05) and a higher proportion of patients with concomitant acute cholecystitis (59.6 vs. 22.2%; P < 0.01).

CONCLUSIONS:

LCBDE with a 100% ductal clearance rate is possible following an algorithm for various approaches. SILCBDE is feasible under a low threshold for procedure conversion. A transcystic approach should be tried first if indicated, and a longitudinal cystic ductotomy to the cystocholedochal junction is beneficial. Prospective, randomized trials comparing single-incision and multi-incision LCBDE are anticipated.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laparoscopía / Conducto Colédoco / Coledocolitiasis Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Taiwán

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laparoscopía / Conducto Colédoco / Coledocolitiasis Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Surg Endosc Asunto de la revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Año: 2018 Tipo del documento: Article País de afiliación: Taiwán
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