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A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis
G Saccomani1, V Durante, M R Magnolia
1Department of Surgery, Ospedale Santa Corona, p.zza XXV Aprile 128, 17027, Pietra Ligure, Italy. giovannisaccomani@ospedalesantacorona.it
Surgical Endoscopy
|May 4, 2005
Summary
Peroperative endoscopic retrograde cholangiopancreatography (ERCP) is effective for common bile duct stones during cholelithiasis management. A one-step approach is faster, while a two-step method reduces complications like pancreatitis.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Biliary Tract Surgery
Background:
- Laparoscopic cholecystectomy (LC) is standard for gallstones, creating challenges for concurrent common bile duct (CBD) stones.
- Management options for choledocholithiasis include pre-LC endoscopic sphincterotomy (ES), laparoscopic or open CBD exploration, and postoperative ERCP.
- Peroperative ES is an emerging alternative technique.
Purpose of the Study:
- To evaluate a routine intraoperative cholangiography technique followed by either one-step peroperative ERCP or a two-step approach with transcystic drain and postoperative ERCP.
- To assess the efficacy and safety of peroperative ERCP for managing choledocholithiasis associated with cholelithiasis.
Main Methods:
- Routine intraoperative cholangiography was performed.
- A 450-cm transcystic guidewire was inserted to facilitate Vater papilla cannulation for ERCP.
- Patients were treated either in one step (peroperative ERCP) or two steps (transcystic drain and postoperative ERCP).
Main Results:
- Successful treatment was achieved in 28 patients in one step and 24 in two steps.
- Mean operative time was shorter for the one-step group (181 min) compared to the two-step group (131 min).
- The one-step group had a shorter mean hospital stay (4.8 days) than the two-step group (9.6 days).
- Postoperative pancreatitis occurred in 14/25 (one-step) vs. 0/17 (two-step) patients; no patient developed pancreatitis postoperatively.
- Three complications (10%) of mild papillary bleeding were observed and managed endoscopically. No mortality occurred.
Conclusions:
- Peroperative ERCP, using the described technique, is recommended as the primary treatment for choledocholithiasis concurrent with cholelithiasis.
- A two-step rendezvous technique is a preferred alternative when single-stage treatment is not feasible.
- The technique facilitates CBD cannulation and offers a safe and effective management strategy.
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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
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