PMID- 28763814
OWN - NLM
STAT- MEDLINE
DCOM- 20190729
LR  - 20191210
IS  - 1439-7803 (Electronic)
IS  - 0044-2771 (Linking)
VI  - 55
IP  - 9
DP  - 2017 Sep
TI  - Three modalities on common bile duct exploration.
PG  - 856-860
LID - 10.1055/s-0043-112655 [doi]
AB  - Background Choledocholithiasis can be managed by transcystic (TC) and transduct 
      (TD) stone extraction or using cholangioscopy through the left hepatic duct 
      orifice (LHD). Objective The aim of this study is to evaluate the safety and 
      effectiveness of common bile duct exploration through the TC approach, TD 
      approach, and LHD approach for choledocholithiasis, with a specific emphasis on 
      the TC and LHD approaches versus the TD approach. Methods Between January 2011 
      and June 2014, a total of 172 choledocholithiasis patients accompanied by 
      cholecystitis and/or left intrahepatic gallstones were scheduled for laparoscopic 
      or open common bile duct (CBD) exploration using cholangioscopy through the CBD 
      (TD group: n = 72), cystic duct (TC group: n = 63), or LHD orifice (LHD group: 
      n = 37). T-tube insertion was performed in selected patients. Patients were 
      regularly followed up at bimonthly intervals or more frequently in presence of 
      any symptom. Primary outcomes measures included overall operative time, length of 
      hospital stay, and postoperative bile leaks. Results Successful bile duct 
      clearance was 100 % in the TD group, 93.6 % in the TC group, and 90.9 % in the 
      LHD group. Sixteen cases in the TD group had T-tube placement in contrast to no 
      cases in the TC and LHD groups. There were more bile leaks after TD stone 
      extraction (12.5 %) than TC (3.2 %) and LHD stone extraction (0 %), which 
      prolonged hospitalization in the TD group more than in the TC and LHD groups. For 
      choledocholithiasis patients accompanied by cholecystitis, 2 groups (TC and TD 
      groups) were comparable in operative time. However, for choledocholithiasis 
      patients accompanied by left intrahepatic gallstones, the LHD group had a 
      significantly shorter operative time than the TD group (121.1 +/- 16.9 minutes vs. 
      149.3 +/- 42.8 minutes, p < 0.05). Conclusion The TD group had a higher stone 
      clearance rate but was associated with a higher risk of bile leaks. TC and LHD 
      stone extraction, which seems to be the more effective approach with lower 
      complication rates, is an accessible technique that simplifies the operation 
      procedure by avoiding choledochotomy and subsequent T-tube insertion.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Zhou, Yong
AU  - Zhou Y
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Wu, Xu-Dong
AU  - Wu XD
AD  - Department of Gastroenterology, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Zha, Wen-Zhang
AU  - Zha WZ
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Fan, Ren-Gen
AU  - Fan RG
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Zhang, Biao
AU  - Zhang B
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Xu, Yong-Hua
AU  - Xu YH
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Qin, Cheng-Lin
AU  - Qin CL
AD  - Department of General Surgery, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
FAU - Jia, Jing
AU  - Jia J
AD  - Department of Nephrology, Yancheng City No. 1 People's Hospital, Yancheng, 
      Jiangsu Province, China.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
TT  - Drei Modalitaten fur das Management der Choledocholithiasis.
DEP - 20170801
PL  - Germany
TA  - Z Gastroenterol
JT  - Zeitschrift fur Gastroenterologie
JID - 0033370
MH  - Bile Ducts/*surgery
MH  - Choledocholithiasis/diagnostic imaging/*surgery
MH  - Choledochostomy/*methods
MH  - Common Bile Duct/*surgery
MH  - Drainage/*methods
MH  - Hepatic Duct, Common/*surgery
MH  - Humans
MH  - Laparoscopy/adverse effects/*methods
MH  - Length of Stay
COIS- Disclosure The authors report no conflicts of interest in this work.
EDAT- 2017/08/02 06:00
MHDA- 2019/07/30 06:00
CRDT- 2017/08/02 06:00
PHST- 2017/08/02 06:00 [pubmed]
PHST- 2019/07/30 06:00 [medline]
PHST- 2017/08/02 06:00 [entrez]
AID - 10.1055/s-0043-112655 [doi]
PST - ppublish
SO  - Z Gastroenterol. 2017 Sep;55(9):856-860. doi: 10.1055/s-0043-112655. Epub 2017 
      Aug 1.