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PubMedDate not supplied

[Computed tomographic cholangiography in the diagnosis of choledocholithiasis in severe bilirubinemia].

Cholangiography used with oral or intravenous contrast agents has gained wide acceptance as the most objective preoperative diagnostic technique for choledocholithiasis. However, an indirect contrasting technique has been found quite unfit in patients with severe bilirubinemia. Despite this, the authors employed indirect contrasting of the bile ducts in 104 patients with severe bilirubinemia in combination with computed tomographic cholangiography. Contrasting took place in 90 (86.5%) patients. In complete obstruction of the choledochus (10 patients), intraductal hypertension prevents the contrast agent and bile from entering the hepatic ducts and the contrast agent is excreted by the kidneys. Thus, the use of the latest equipment and computers allows one to detect minor biliary contrast concentrations during indirect contrasting of the biliary tract in severe bilirubinemia.

Aged↗
PubMed1996

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Aged↗
PubMed1997

[Choledocholithiasis: semeiotic and diagnostic accuracy of cholangiography with magnetic resonance].

The authors report their experience in the optimization of the diagnostic accuracy of Magnetic Resonance Cholangiography (MRC) to detect choledochal stones; pre- and post-MIP post-processing images were compared. Thirty patients with dilated biliary ducts (mean age: 55.6 years) were examined with MRC; two of them had stones in the intrahepatic biliary ducts. The gold standard and the inclusion criterion was ERCP. MRC was carried out with a 1.5 T superconductive magnet (Signa) with T2-weighted FAST SE sequences (TR/TE; 10000/256, matrix: 256 x 128, slice thickness: 3 mm, TA: 6 min 28 s). Coronal MR images were blindly studied before and after MIP post-processing; Friedman's test was used for statistical analysis (p < .05). ERCP showed 92 cases of choledocholithiasis, with the stones ranging .2 to 3.4 cm; MRC before MIP post-processing had 97.1% diagnostic accuracy, 97.8% sensitivity and 95.8% specificity. These values are significantly different from those obtained after MIP (91.4%, 86.9% and 95.8% respectively). In our experience, pre- and post-MIP post-processing MRC can be considered a reliable and accurate noninvasive technique to detect choledochal stones.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

Bilioma secondary to choledocholithiasis.

Bilioma secondary to choledocholithiasis is rare. We report a patient in whom a large common bile duct stone was responsible for leak from the infraduodenal segment of the bile duct. Choledochotomy with extraction of stone followed by T-tube drainage of the bile duct and evacuation of the bilioma resulted in complete recovery.

Bile↗
PubMed1998

[Treatment of choledocholithiasis].

Passage of gallstones into the common bile duct occurs in 10-15% of patients with cholecystolithiasis. The incidence of common bile duct stones increases with age of the patient and can reach up to 50% in certain series. The diagnosis of choledocholithiasis is usually made by endoscopic retrograde cholangiography (ERC), either preoperatively or intraoperatively at the time of laparoscopic cholecystectomy. Endoscopic sphincterotomy followed by balloon or basket extraction is the method of choice for the management of patients with common duct stones.

Gallstones↗
PubMed1998

[Surgical therapy of choledocholithiasis].

Following the introduction of endoscopic papillotomy and stone extraction, surgical bile duct revision has decreased considerably in importance during the past two decades. Surgical bile duct revision is associated with an appreciably higher rate of complications than endoscopic stone extraction. The result has been that most working groups now favour a "therapeutic splitting" approach. This means that, wherever possible, endoscopic revision of the bile duct is first attempted. If, during laparoscopic cholecystectomy, intraoperative cholangiography reveals the presence of bile duct stones, they may, after consultation with the endoscopist, be left in place for removal by endoscopic papillotomy at some later date. Only in the case of very young patients and exceptionally, a highly experienced laparoscopic surgeon may attempt a transcystic extraction of such stones. Continuing indications for conventional surgical treatment of choledocholithiasis are local factors obstructing access to the papilla (gastrectomy, stenosis of the pylorus) and other bile duct changes requiring correction (choledochocele, strictures, stenoses, Mirizzi's syndrome, over-looked impacted stone obstructing an over-long cystic duct stump, intrahepatic lithiasis).

Adult↗
PubMed1998

[Endoscopic diagnosis and therapy of cholecysto- and choledocholithiasis].

Not only for systematical reasons a differentiation of gallstones disease between cholecystolithiasis and choledocholithiasis is sensible. Although the two diseases are basically caused by gallstones, they generally differ in diagnostic and therapeutic strategies. While the cholecystolithiasis is the domain of visceral surgeons and today almost exclusively and definitively cured by microinvasive cholecystectomy, for the treatment of choledocholithias there are required the endoscopic procedures of physicians.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Laparo-endoscopic "rendezvous": a new technique in the choledocholithiasis treatment.

BACKGROUND/AIMS: Endoscopic sphincterotomy for common bile duct stone clearance during laparoscopic cholecystectomy may fail due to difficulties in cannulating the papilla major. In this study we propose a new technique that facilitates the cannulation of the papilla and the common bile duct stone clearance during a standard laparoscopic cholecystectomy. Its clearance percentage, complication rate and post-operative stay have been evaluated and compared with standardized procedures such as open surgery and endoscopic sphincterotomy before laparoscopic cholecystectomy. METHODOLOGY: In a group of 16 patients presenting with cholelithiasis and common bile duct stones or papillitis, the sphincterotome was driven across the papilla into the choledochus by a Dormia basket passed in the duodenum through the cystic duct during laparoscopic cholecystectomy. Measures of outcome were clearance rate, mortality, morbidity and hospital stay. Furthermore, data obtained from this sample of patients were compared with those from another two groups of 16 patients in which choledocholithiasis was managed either by endoscopic sphincterotomy performed before laparoscopic cholecystectomy or by open cholecystectomy and trans-duodenal sphincterotomy. RESULTS: The rate of cannulation of the papilla and of the common bile duct stone clearance was 100% when the combined endo-laparoscopic approach was used in 15 patients with endoscopic sphincterotomy (93,7%) and in 15 patients with open sphincterotomy (93,7%), cholecystectomy was successful in every case. The groups were statistically similar with regard to complications; none of the patients required blood transfusion. The mean post operative stay was 95.2 hours (range 48-240) for the first group, 350.1 hours (range 192-1680) for the second and 69.7 hours (range 24-132) for the third. CONCLUSION: The laparo-endoscopic rendezvous, though still in evolution, is an efficacious method which can be used during the laparoscopic strategy of common bile duct clearance.

Adult↗
PubMed1998

[Endoscopic treatment of choledocholithiasis in patients with Billroth II gastrectomy by dilatation with papillary balloon].

Two patients with Billroth II gastrectomy and choledocholithiasis are presented. Treatment with endoscopic retrograde cholangiography and dilatation with papillary balloon allowed lithiasis extraction. The evolution following the procedure was favorable with no complications being observed. The advantages and disadvantages of papillary balloon dilatation in comparison with endoscopic sphincterotomy are reviewed.

Aged↗
PubMed1998

[Current approaches to the diagnosis and treatment of residual choledocholithiasis].

Residual calculi were removed by different methods in 704 patients aged 22-86 years having residual choledocholithiasis. The author considers non-operative eradication of it to be a preferable method for patients with the external drain of bile ducts, for patients without the drain endoscopic papillosphincterotomy (EPST) should be chosen. The removal of residual concrements with the Dormia basket through the external bile fistula gave positive results in 94.5% of cases. The effectiveness of EPST in removing the calculi without the external drain was 86%. Reoperations were performed in 9.5% of the patients. Long-term results were followed up in all the patients during 5 years: good long-term results after non-operable removal of the residual calculi through the external duct were from 92% during the first 3 years to 98% in the following 7-10 years.

Adult↗
PubMed2003

Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy. A matched case-control study.

BACKGROUND: The purpose of this prospective study was to evaluate if a recently proposed score system based on six preoperative parameters [history of colic pain and/or jaundice, dyspepsia, cholecystitis, ultrasound (US), evidence of common bile duct stones (CBDS), number and size of gallbladder stones at US, level of serum glutamic oxalacetic transaminase and/or alkaline phosphatase is effective in the selection of patients undergoing laparoscopic cholecystectomy (LC) with asymptomatic CBDS and could allow a significant reduction of the total number of preoperative examinations. METHODS: In the case group, 408 patients were categorized into low-, medium-, and high-risk classes and underwent, respectively, no further preoperative assessment of the bile duct, intravenous cholangiography (IVC), and endoscopic retrograde cholangiography (ERC). Intraoperative cholangiography (IOC) was performed whenever the surgeon was in doubt as to biliary anatomy or bile duct clearance. These patients were compared with 408 retrospectively matched patients (control group) undergoing routine preoperative IVC and/or ERC. RESULTS: In the case group, significantly lower numbers of IVC (120 vs 392) and IOC (3 vs 16) were performed ( p < 0.005), whereas no difference in the total number of ERCs was noted. One patient in the control group had retained CBDS detected during follow-up evaluation, whereas none occurred in the case group. CONCLUSION: The proposed scoring system allows selective use of IVC, ERC, and/or IOC in patients undergoing elective LC.

Adult↗
PubMed2004

Laparoscopic treatment of choledocholithiasis using modified biliary stents.

BACKGROUND: When common bile duct (CBD) stones are present, the laparoscopic approach is widely used. For postoperative biliary decompression, T-tube insertion is the most traditional method. Antegrade biliary stenting is another method that could eventually replace the T-tube. METHODS: This study involved 86 patients with CBD stones who underwent laparoscopic CBD exploration. A simple modification was made to the biliary stent by eliminating the proximal flap, and we adopted this as a routine biliary decompression device. This modified biliary stent (MBS) was inserted in 50 patients (MBS group), and the T-tube was used for 36 patients (T-tube group). RESULTS: The mean operative time and the overall complication rate were similar between the two groups. There was no mortality. The mean hospital stay was significantly shorter for the MBS group. Biliary stents were eliminated spontaneously via the gastrointestinal tract among 36 (81.8%) patients, and for 8 patients, the stents had to be removed endoscopically. Six patients were lost to follow-up evaluation. The mean time that elapsed until spontaneous stent elimination was 11.5 +/- 9.5 days. CONCLUSIONS: Among the different methods of biliary decompression, MBS renders the patients free of an uncomfortable T-tube. Morbidity and even mortality associated with T-tubes are eliminated, and the hospital stay may be shortened. Therefore, for selected patients, the modified biliary stent may be a better option than the traditional T-tube.

Aged↗
PubMed2005

Conversion rate of laparoscopic cholecystectomy after endoscopic retrograde cholangiography in the treatment of choledocholithiasis: does the time interval matter?

BACKGROUND: Preceding endoscopic retrograde cholangiography (ERC) in patients with choledochocystolithiasis impedes laparoscopic cholecystectomy (LC) and increases risk of conversion. We studied the influence of time interval between ERC and LC on the course of LC. METHODS: All patients treated for choledochocystolithiasis with ERC and LC during 1996-2001 were studied retrospectively, comparing the course of LC in three time interval groups; LC < 2, 2-6, and > 6 weeks after ERC. PRIMARY OUTCOMES: adhesions, bile duct injury, operating time, and conversion-rate. RESULTS: Eighty-three patients were studied (group 1, n = 23; group 2, n = 15; group 3, n = 45). Adhesions, operation time, and bile duct damage did not significantly differ between the groups. The conversion rate in group 2 is significantly higher compared to group 1 (p = 0.027, OR 11 (1.13-106.8)) CONCLUSIONS: A higher conversion rate of LC is found 2-6 weeks after ERC compared to LC within 2 weeks. However, further research is needed to gain more reliable data on whether this is caused by timing.

Adolescent↗