Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Choledocholithiasis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed2000

[ALL complicated by obstructive jaundice due to choledocholithiasis after unrelated bone marrow transplantation].

A 22-year-old man with acute lymphocytic leukemia underwent allogeneic bone marrow transplantation (BMT) from an unrelated donor in October 1996. In April 1997, he suddenly developed severe abdominal pain with nausea and vomiting. The diagnosis was obstructive jaundice associated with gallstones in the gallbladder and common bile duct. The patient underwent laparoscopic cholecystectomy and endoscopic removal of the stones in the common bile duct. The major component of the gallstones was bilirubinate calcium. Although the pathogenesis of gallstones after BMT remains unclear, several factors including impaired contractility of the gallbladder, hemolysis, changes in bile composition, and biliary tract infection may play important roles.

Adult↗
PubMed2000

Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction.

Management of common bile duct (CBD) stones during pregnancy is a difficult problem. The authors reported the case of a patient who was 22 weeks' pregnant who had a symptomatic CBD stone successfully treated by the association of magnetic resonance cholangiography and laparoscopic CBD stone removal. The patient delivered a healthy baby boy at 39 weeks. Magnetic resonance cholangiography and laparoscopic CBD exploration is a viable option in the management of CBD stones in pregnant patients that carries a low risk for the fetus while preserving the advantages of minimally invasive surgery for the mother.

Adult↗
PubMedDate not supplied

Treatment of choledocholithiasis: therapeutic ERCP versus peroperative extraction during laparoscopic cholecystectomy.

Limitation for preoperative ERCP/ES before laparoscopic cholecystectomy in patients scheduled for laparoscopic cholecystectomy are (1) Additional invasiveness of endoscopic procedures in patients supposed to be fitted for surgery, (2) A high rate of useless procedures due to the low predictive value of suspicion criteria for common bile duct stones (CBDS), (3) an inability to detect and treat all patients with CBDS, and (4) so far, an absence of demonstration of the superiority of this split therapeutic approach versus a one stage surgical treatment. Published series of CBDS extraction during laparoscopic cholecystectomy have included more than 2000 patients. Results and complications of this one stage laparoscopic approach compares favourably to the conventional open surgical treatment. In one randomized trial endoscopy plus laparoscopy was not demonstrated superior to laparoscopy alone. Intraoperative diagnosis and treatment of CBDS during laparoscopic cholecystectomy is the most cost efficient approach for patients with or without preoperative suspicion of CBDS, provide they are fitted for surgery.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2000

[Ultrasound study and computerized tomography in the diagnosis of choledocholithiasis].

A comparative analysis of the results of using the ultrasonic investigation and computed tomography in differential diagnosis of jaundice was made in 205 patients. The reliability of USI in diagnosis of cholelithiasis was 54.3%, and that of standard CT was 55.9%. The authors have developed and used computed tomocholangiography (direct and indirect) in 187 patients with pronounced bilirubinemia. Indirect tomocholangiography was used in patients with bilirubinemia not more than 157 mkm/l. Contrasted main bile ducts were noted in 95% of the patients. When the content of bilirubin in blood plasma was higher than the figures shown, the authors used the direct contrast of the bile ducts in combination with computed tomography. When using more perfect X-ray devices (CT) with the greater resolving power for diagnosis in jaundice patients, it was possible to get the overwhelming information about the state of the bile ducts.

Adult↗
PubMedDate not supplied

Management of choledocholithiasis found during laparoscopic cholecystectomy: a strategy based on the use of postoperative endoscopic retrograde cholangiography and sphincterotomy.

BACKGROUND: Several strategies have been proposed for the diagnosis and management of common bile duct stones in candidates for laparoscopic cholecystectomy. METHODS: Clinical characteristics, treatment, and outcome of five patients in whom CBDS were demonstrated by intraoperative cholangiography during a laparoscopic cholecystectomy were analyzed. All patients were treated by endoscopic sphincterotomy. Post-treatment outcome was emphasized. RESULTS: Mean age of the patients was 55 years. Four were female and one male. Preoperative liver function tests were within normal range in all patients. Duct stones of a mean size of 0.8 cm were found in the lower third of the biliary tree. Four were retrieved by endoscopic sphincteroplasty using a Dormia basket and in one patient after an unsuccessful endoscopic attempt, an open choledochoduodenostomy was performed. There were no post-treatment complications. At a mean follow-up of 2 years no evidence of recurrent common bile duct obstruction has been found in any patient. CONCLUSIONS: This small series supports the use of postoperative endoscopic retrograde cholangiography and sphincteroplasty in patients with unsuspected common bile duct stones found during laparoscopic cholecystectomy. Retrieval of the stones immediately after surgery at the operative room is recommended.

Adult↗
PubMedDate not supplied

[Single-stage laparoscopic surgery of cholelithiasis and choledocholithiasis in 268 unselected consecutive patients].

AIMS: The introduction of laparoscopic cholecystectomy (LC) has modified the treatment of gallstones and common bile duct (CBD) stones. Aim of this prospective study was to evaluate the results of single stage laparoscopic management of gallstones and CBD stones. PATIENT AND METHODS: From January 1991 to October 1999, CBD stones were present at intraoperative cholangiography in 268 patients (pts) (169 females, 99 males, mean age 55.6 years, range 12-94 years) out of 2693 undergoing LC (10%) for gallstones. CBD stones were unsuspected in 123 (45.9%) and suspected in 145 (54.1%). RESULTS: CBD exploration was successful in 264 cases (98.5%) (transcystic 164, choledochotomy 100). Four pts were converted to open surgery (1.5%). Retained stones in 15 patients (5.7%), were treated by ERCP/ES (6 pts) and by percutaneous endoscopic/fluoroscopic stone removal (6 pts). Spontaneous stones passage occurred in 2 pts, one patient is waiting for treatment. Major morbidities were hemoperitoneum (4 cases) and cystic duct bile leakage (3 cases). One high risk patient died postoperatively. Recurrent stones were observed in 5 pts (1.9%), at 1, 4, 8, 18, 26 months respectively after T-tube removal, and were treated by ERCP/ES in 4 cases. Spontaneous stone passage occurred in 1 case. CONCLUSIONS: LC and CBD exploration has shown to be safe and feasible with low morbidity and mortality. The rationale of this approach is to solve two problems during the same procedure, limiting the role of endoscopic sphincterotomy to the treatment of residual ductal stones.

Adolescent↗
PubMedDate not supplied

Rapid diagnosis of choledocholithiasis using biochemical tests in patients undergoing laparoscopic cholecystectomy.

BACKGROUND/AIMS: The present study was designed to identify the biochemical tests which could detect the presence of common bile duct stones in patients with symptomatic gallstones, without other invasive investigations. The usefulness of biochemical tests may reduce the necessity of endoscopic retrograde cholangiopancreatography prior to laparoscopic cholecystectomy. METHODOLOGY: 3000 patients with symptomatic laparoscopic cholecystectomy scheduled for laparoscopic cholesystectomy were included in the study. 458 patients (201 men, 257 women; mean age, 57.7 +/- 14.6 yrs) were examined with endoscopic retrograde cholangiopancreatography for suspected common bile duct stones. The serum tests for liver function, including a measurement of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, gamma-glutamyltransferase and albumin were obtained on admission prior to the ultrasonography, and the endoscopic retrograde cholangiopancreatography. RESULTS: The six significant factors, including alkaline phosphatase, direct bilirubin, total bilirubin, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase were identified by the univariate analysis and the multivariate logistic regression analysis which identified alkaline phosphatase and gamma-glutamyltransferase, as the two significant independent factors. A statistical model was developed with a formula of [formula: see text] A curve of receiver operating characteristics was constructed to identify an alkaline phosphatase level greater than 300 U/L or a gamma-glutamyltransferase level greater than 420 mU/mL which would have both higher sensitivity and specificity. CONCLUSIONS: Biochemical tests can be a significant aid to the clinician's decision-making when predicting the presence of common bile duct stones in patients with gallstones.

Adult↗
PubMed2001

[Combined treatment of patients with acute cholecystitis complicated by choledocholithiasis and mechanical jaundice].

A scheme of combined treatment was used in 72 patients with a complicated form of cholelithiasis. It included retrograde pancreatocholangiography followed by endoscopic papillosphincterotomy, intraoperative cholangiography and drainage of the common bile duct after Pikovsky. There was not a single case of transition to traditional cholecystectomy. Four complications in the postoperative period were obviated during relaparoscopy.

Acute Disease↗
PubMed2001

[Acute cholangitis caused by choledocholithiasis: traditional surgery or endoscopic biliary drainage].

BACKGROUND: Endoscopic drainage of the biliary tree for acute cholangitis is a therapeutic modality with a lower mortality and complication rates. AIM: To compare endoscopic drainage with surgical treatment in the emergency management of acute cholangitis. PATIENTS AND METHODS: Between 1995 and 1998, sixty five patients with acute cholangitis were subjected to an endoscopic drainage of the biliary tree. In the same period, 40 patients were treated with traditional surgical procedures. The evolution of both groups of patients were compared. RESULTS: Sixty two patients (95.4%) subjected to endoscopic treatment had a satisfactory evolution, compared with 23 (58%) of those operated (p < 0.001). Five operated patients and no individual subjected to endoscopic drainage died (p < 0.01). Mean postoperative hospital stay of operated patients was 15.5 +/- 19.6 days compared to 5.8 +/- 4.2 days in those subjected to endoscopic drainage (p < 0.001). Definitive resolution of biliary obstruction was achieved in 83% of patients subjected to endoscopic drainage or traditional surgery. CONCLUSIONS: Endoscopic drainage has a lower rate of complications and mortality than traditional surgery, in the treatment of acute cholangitis.

Acute Disease↗
PubMed2001

[Application of laparoscopic technologies in the treatment of choledocholithiasis].

Pre-operation algorithm of diagnostics of cholecystolithiasis was elaborated and inculcated into clinical practice. The results of treatment of 6120 patients with cholecystitis were analyzed. Based on this, the indications and method of performance of laparoscopic intervention on common bile duct are substantiated and results in 73 patients are given. Laparoscopic revision with sanation of biliary ducts was successful in 95% of patients. The complications occurred in 11 patients (15%), all patients remained alive.

Adolescent↗
PubMed1999

Prevalence and laparoscopic ultrasound patterns of choledocholithiasis and biliary sludge during cholecystectomy.

A prospective study of laparoscopic ultrasound (LUS) for evaluation of the common bile duct during laparoscopic cholecystectomy was started in October 1993. LUS during cholecystectomy was performed routinely to preoperatively identify unsuspected stones. Three-hundred thirty patients with symptomatic cholelithiasis were included in the study. The preoperative work-up included endoscopic retrograde cholangiopancreatography in 49 patients. Common bile duct (CBD) stones were found in 22 cases; in 19 cases the stones were removed successfully by endoscopic sphincterotomy. LUS successfully visualized the CBD in all but 10 patients (3%). CBD stones were found in 17 patients and confirmed by preoperative cholangiography and/or CBD exploration. There were two false-negative and one false-positive result for LUS. In 47 patients (14.2%) LUS detected CBD sludge as low-amplitude echoes without acoustic shadowing. The presence of CBD sludge was correlated with some biochemical and clinical variables. A significant correlation was identified between the absence or presence of CBD sludge and endoscopic retrograde cholangiopancreatography, acute pancreatitis, gallbladder sludge, age, and the levels of serum bilirubin and alkaline phosphatase. A significant difference was recorded between CBD diameter and the presence or absence of stones or sludge (p = 0.00001). In our experience, LUS allowed good diagnosis of CBD stones during laparoscopic cholecystectomy. The clinical significance of CBD sludge remains to be elucidated.

Adolescent↗
PubMed2001

[Endoscopic mechanical lithotripsy in the treatment of choledocholithiasis].

The method of endoscopic intraduct cleavage of calculi was used in 78 patients from 19 to 88 years of age. History of operations on bile ducts had 35 of them, laparoscopic cholecystectomy was performed in 43 patients after the endoscopic sanitation of the bile ducts. Three cases are described as illustration.

Adult↗
PubMed2001

[Residual choledocholithiasis in elective cholecystectomy and choledocholithotomy].

Cholecystectomy is one of the most frequent abdominal operation. Common bile duct stone may be found in 6-15% of elective cholecystectomics. One or more stones may be left behind within common bile duct. In a series of 106 consecutive cholecystectomics performed in the First surgical clinic in Belgrade over six months period (from 07.08.1997.-31.12.1997.) operative cholangiography was performed routinely in every single case. Unexpected common bile duct stone was found in 13 patients (12.26%). After removal of stones choledochoscopy was performed in 7 out of 13 patients with common bile duct stone (53.8%). An operative T-tube cholangiography was performed in all 13 cases before closure of the abdomen. Postoperatively, usually from 8th to 10th day a secondary T-tube cholangiography in the X-ray department was performed in all 13 cases. Retained stone was found in 2 patients, both in group of patients in whom choledochoscopy had not been carried out. The retained stone was successfully removed endoscopically in one case but the second patient had to be reoperated as endoscopy was unsuccessful. We conclude that choledochoscopy reduces the risk of retained common bile duct stone and it should be practiced whenever possible.

Adult↗