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Laparoscopic choledocholithotomy with rigid nephroscope
1Department of Surgery, MLB Medical College, Jhansi, Uttar Pradesh, India. sinha_rga@yahoo.co.in
Insights
Laparoscopic common bile duct lithotomy using a rigid scope is a feasible and affordable alternative for removing large impacted stones. This method offers advantages over flexible choledochoscopes, particularly in terms of cost and effectiveness.
Area of Science:
- Surgical Innovation
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Flexible choledochoscopes for laparoscopic common bile duct lithotomy (LCDL) are costly and less effective for large impacted stones.
- A need exists for more affordable and efficient tools for LCDL.
Purpose of the Study:
- To evaluate the feasibility, effectiveness, and cost-efficiency of using a rigid nephroscope for transdochal laparoscopic common bile duct lithotomy (LCDL).
Main Methods:
- 172 consecutive patients with common bile duct stones underwent laparoscopic cholecystectomy and transdochal LCDL using a rigid nephroscope.
- The common bile duct was closed with sutures or a T tube.
- Perioperative parameters were recorded.
Main Results:
- Transdochal LCDL was successful in 172 patients, with a low conversion rate (4.65%) to open surgery.
- The procedure was effective for large and impacted stones (4-12 mm).
- Postoperative complications were minimal, including mild pancreatitis and biliary peritonitis.
Conclusions:
- Rigid scope transdochal LCDL is a feasible, effective, and more affordable option for managing common bile duct stones.
- This technique is particularly advantageous for large impacted stones.
- It presents a cost-effective alternative to flexible choledochoscopy.
Background:
Apart from the required expertise, a major deterrent to laparoscopic common bile duct (CBD) lithotomy (LCDL) remains the relatively prohibitive cost of the flexible choledochoscope, and it also has a shortcoming of not being effective in removal of large impacted CBD stones.
Subjects And Methods:
All patients presenting with CBD stones were treated, without exclusion, by laparoscopic cholecystectomy plus transdochal LCDL after relevant investigations. LCDL was performed using a rigid nephroscope. The CBD was closed either with running 3-0 polyglactin acid (Vicryl; Ethicon) sutures without a stent or around a T tube in a few patients. Perioperative parameters were recorded in all patients.
Results:
Transdochal LCDL was performed on 172 consecutive patients. Five patients had a prior open cholecystectomy, 26 patients presented with acute cholecystitis, 5 patients presented with mild acute pancreatitis, and 12 patients presented after failed endoscopic retrograde cholangiopancreatography. Twenty-eight (16.28%) patients had multiple stones, 2 had biliary sludge, and no stone was found in 3 patients. Stone size varied from 4 to 12 mm. The average operative time was 68 minutes (range, 45-127 minutes). Primary repair was performed with 3-0 Vicryl continuous sutures, and the T tube was left in place in 13 (7.56%) patients. Conversion to an open procedure was required in 8 patients (4.65%). Postoperatively, mild acute pancreatitis occurred in 1 patient, and biliary peritonitis occurred in 5 patients.
Conclusions:
Rigid scope transdochal LCDL is feasible, probably easier, better for impacted large CBD stones, and definitely more affordable.
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