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PubMed1998

Choledocholithiasis: percutaneous treatment.

The percutaneous approach to retained biliary duct stones is most reasonable in the presence of a T-tube because of the low morbidity and mortality as well as its low cost. We report our experience with 373 patients, emphasizing the technique and the solutions to some frequent problems.

Cholangiography↗
PubMed1996

A case of choledocholithiasis with an endoclip nidus, 6 months after laparoscopic cholecystectomy.

A 69-year-old man developed obstructive jaundice 6 months after laparoscopic cholecystectomy. Endoscopic retrograde cholangiography suggested a common bile duct (CD) stone. A second operation was performed, and this revealed a CBD stone with an endoclip as a nidus. Since laparoscopic surgery has become a very common procedure, endoclips are used more frequently. Therefore, careful surveillance and strict follow-up are stressed to avoid CBD stone and various other complications caused by endoclips.

Aged↗
PubMed2001

Evaluation of the predictors of choledocholithiasis: comparative analysis of clinical, biochemical, radiological, radionuclear, and intraoperative parameters.

This prospective study was performed to assess the predictive ability of the various indicators of common bile duct (CBD) calculi, individually or in combination, by analyzing 88 patients with gallstone disease. The patients were classified into two groups according to the presence of 10 predefined criteria. Of 53 patients with one or more risk factors (group 2), 26 harbored CBD calculi; none of 35 patients with no risk factors (group 1) had CBD stones. Jaundice correlated best, with a sensitivity of 69%; and pancreatitis had the lowest sensitivity (12%). Elevated serum bilirubin and alkaline phosphatase levels correlated better than liver enzymes and serum amylase. The sensitivity and negative predictive value of cholescintigraphy scanning for diagnosing CBD calculi were better than those of ultrasonography, the sensitivity being 84% versus 50% and the negative predictive value 95% versus 82%. Endoscopic retrograde cholangiopancreaticography was successful in 94% of the patients, and CBD calculi were diagnosed in 74%. Moreover, peroperative cholangiography was 100% sensitive with no false-positive results. Ultimately, a palpable stone at surgery was the best predictor. When all the criteria were analyzed, it was found that as the number of criteria increased so did the percentage of patients harboring CBD calculi.

Adult↗
PubMed1984

Side-to-side choledochoduodenostomy in the management of choledocholithiasis and associated disease. Facts and fiction.

Ascending cholangitis, the sump syndrome, and alkaline reflux gastritis are drawbacks commonly ascribed to side-to-side choledochoduodenostomy. Most surgeons consider side-to-side choledochoduodenostomy as a last resort measure to be utilized only in elderly patients and only on ducts wider than 15 mm. In trying to assess the pertinence of such alleged inconveniences and limitations, a series has been analyzed (retrospectively until 1976 and prospectively from then on). A total of 70 of these operations were performed from January 1973 to September 1982, on 53 women and 17 men. Twenty-six percent were less than 50 years of age, and 30 percent were over 70 years of age. Sixteen of the 70 operations were reoperations that took place several years after cholecystectomy. Intravenous cholangiographic films were obtained preoperatively for evaluation of the duct width which was less than 15 mm in 23 patients (33 percent). The follow-up period, surpassing 2 years in 35 patients (50 percent), includes clinical interviews and liver biochemistry measurements every 6 months, and endoscopic retrograde cholangiopancreatography 12 to 18 months postoperatively. There was one postoperative death (1.4 percent), and significant morbidity developed in five patients (7.1 percent). The postoperative hospital stay averaged 8 days. The long-term results were classified as excellent in 50 patients, good in 15 patients, fair in 3 patients, and poor in 1 patient. Side-to-side choledochoduodenostomy is a safe, very effective therapeutic measure, even when performed on ducts less than 15 mm wide, provided a few technical requirements are respected. It does not carry the inconveniences that have usually been ascribed to it. The excellent long-term results in the present series have allowed us to liberalize its utilization, especially in young patients.

Aged↗
PubMed1984

Choledochoscopy in surgery for choledocholithiasis. Six year experience in 380 consecutive patients.

Choledochoscopy is a definite advance in biliary surgery as it simplifies the operative procedure and decreases the retained stone rate. Easy to perform without special training, its use is cost-effective. Therefore, we agree with Kappes et al [10] recommendation that routine intraoperative biliary endoscopy be performed in all patients undergoing common bile duct exploration.

Adolescent↗
PubMed1990

The use of endoscopy to treat bronchobiliary fistula caused by choledocholithiasis.

Bronchobiliary fistula is a rare disorder consisting of the formation of a passageway between the biliary ducts and the bronchial tree. We describe an 87-yr-old woman who had a bronchobiliary fistula secondary to obstruction caused by multiple common bile duct stones. The diagnosis was confirmed by the presence of bile in the sputum and transhepatic cholangiography. Successful stone extraction with balloon and basket techniques and endoscopic sphincterotomy decompressed the biliary tract and was followed by healing of the bronchobiliary fistula without surgical intervention, which has heretofore been considered the only successful means of treatment.

Aged↗