{"title":"单阶段腹腔镜胆总管探查术(LCBDE)和胆囊切除术加胆道内引流术治疗胆石症合并胆总管结石的围手术期效果和可行性:一家三甲医院的报告。","authors":"Ankita Bajpai, Akshay Anand, Awanish Kumar, Manish Agrawal, Ajay Kumar Pal, Pankaj Kumar, Amit Karnik, Sumit Rungta, Harvinder Singh Pahwa, Abhinav Arun Sonkar","doi":"10.1111/ases.13418","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included <i>n</i> = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The study population had a mean age of 42.2 years, with 83% (<i>n</i> = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in <i>n</i> = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.</p>\n </section>\n </div>","PeriodicalId":47019,"journal":{"name":"Asian Journal of Endoscopic Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.9000,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Perioperative Outcomes and Feasibility of Single-Stage Laparoscopic Common Bile Duct Exploration (LCBDE) and Cholecystectomy With Internal Endo-Biliary Drainage for Management of Concomitant Cholelithiasis With Choledocholithiasis: A Report From a Tertiary Care Hospital\",\"authors\":\"Ankita Bajpai, Akshay Anand, Awanish Kumar, Manish Agrawal, Ajay Kumar Pal, Pankaj Kumar, Amit Karnik, Sumit Rungta, Harvinder Singh Pahwa, Abhinav Arun Sonkar\",\"doi\":\"10.1111/ases.13418\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included <i>n</i> = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The study population had a mean age of 42.2 years, with 83% (<i>n</i> = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in <i>n</i> = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.</p>\\n </section>\\n </div>\",\"PeriodicalId\":47019,\"journal\":{\"name\":\"Asian Journal of Endoscopic Surgery\",\"volume\":\"18 1\",\"pages\":\"\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2024-11-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Asian Journal of Endoscopic Surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/ases.13418\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Journal of Endoscopic Surgery","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ases.13418","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Perioperative Outcomes and Feasibility of Single-Stage Laparoscopic Common Bile Duct Exploration (LCBDE) and Cholecystectomy With Internal Endo-Biliary Drainage for Management of Concomitant Cholelithiasis With Choledocholithiasis: A Report From a Tertiary Care Hospital
Introduction
Managing choledocholithiasis alongside cholelithiasis has seen significant evolution, presenting options such as single-stage cholecystectomy with common bile duct (CBD) exploration, or a two-stage procedure involving endoscopic retrograde cholangiopancreatography (ERCP) performed before or after cholecystectomy. Evidence from Western settings may not fully capture the unique disease burden and demographic characteristics prevalent in developing countries. Laparoscopic common bile duct exploration (LCBDE) is more commonly performed in the Indian subcontinent compared to Western centers due to limited access to advanced procedures and specialized instrumentation for complex ERCP cases. The high cost and the need for extensive armamentarium in managing failed ERCPs make LCBDE a more feasible option in many Indian centers.
Methods
This prospective study, conducted from August 2019 to July 2020 at King George's Medical University, UP, India, included n = 24 patients diagnosed with choledocholithiasis. The operative procedures performed included laparoscopic CBD exploration and cholecystectomy, along with internal endo-biliary drainage. Perioperative outcomes were assessed, and follow-up data were included to monitor any recurrence until 36 months post-surgery.
Results
The study population had a mean age of 42.2 years, with 83% (n = of the patients being female). Abdominal pain was the predominant symptom, reported by 91.66% of the patients, followed by nausea/vomiting in 79.20% of cases. The mean CBD diameter observed was consistent with existing literature. The mean operating time was 2.02 h, with primary duct closure taking an average of 13.66 min. Mean blood loss during surgery was 136.25 mL. The average hospital stay was 5.54 days, with the majority of drain removals occurring by the third postoperative day. Complications included fever in 25.0% of the patients and bile leakage in n = 3 out of 24 cases (~12.50%). During the follow-up period, one patient (4.17%) experienced a retained stone.
Conclusion
Laparoscopic CBD exploration with primary duct closure and internal biliary drainage appears to be a feasible approach, yielding satisfactory perioperative outcomes. However, further studies are required to firmly establish its superiority over alternative approaches within the Indian context.