Efficacy analysis of primary closure with two or three endoscopes through cystic duct for treatment of gallbladder stone with secondary common bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TANG Shichuan , PENG Wenbin , ZHENG Qinyue , LIU Jinheng , CHEN Anping ,  YIN Sineng

Department of Hepatobiliary Surgery, Chengdu Affiliated Hospital of Zunyi Medical University (Chengdu Second People’s Hospital), Chengdu 610015, P. R. China;

Corresponding?author：

YIN Sineng, Email: doctoryinsn@sina.com

Keywords：

gallbladder stone with secondary common bile duct stone; transcystic duct pathway; two endoscopes; three endoscopes; primary closure

DOI：

10.7507/1007-9424.201909066

Video：

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Objective To investigate clinical efficacy and advantages and disadvantages of primary closure with two endoscopes (1aparoscope+choledochoscope) or three endoscopes (laparoscope+choledochoscope+duodenoscope) through the cystic duct for treatment of gallbladder stone with secondary common bile duct (CBD) stones.Methods The clinical data of 83 patients with gallbladder stones with secondary CBD stones treated by two or three endoscopes combined with CBD exploration and lithotomy and primary closure through cystic duct from January 2017 to December 2018 in the Chengdu Second People’s Hospital were collected retrospectively. Among them, 41 patients were treated by two endoscopes mode (two endoscopes group), 42 cases were treated by three endoscopes mode (three endoscopes group).Results There were no significant differences in the general conditions such as the gender, age, preoperative diameter of CBD, chronic diseases, etc. between the two and three endoscopes group (P>0.05). All 83 cases underwent the operations successfully and recovered well. The success rate of operation, stone clearance rate, drainage volume of abdominal drainage tube on day 1 after the operation, time of abdominal drainage tube removal after the operation, and hospitalization time had no significant differences between these two groups (P>0.05). The time of operation, intraoperative bleeding volume, and the postoperative pancreatitis rate in the three endoscopes group were significantly more (or higher) than those in the two endoscopes group (P<0.05), but the condition of liver function recovered after the operation was better than that in the two endoscopes group (P<0.05).Conclusions With the strict control of the operation indications, it is safe and feasible to use two or three endoscopes through the cystic duct pathway and primary closure of CBD for treatment of gallbladder stone with secondary CBD stones. However, the choice of operative methods of two or three endoscopes should be based on the general situation of the patients before and during the operation.

Citation： TANG Shichuan, PENG Wenbin, ZHENG Qinyue, LIU Jinheng, CHEN Anping, YIN Sineng. Efficacy analysis of primary closure with two or three endoscopes through cystic duct for treatment of gallbladder stone with secondary common bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(7): 819-824. doi: 10.7507/1007-9424.201909066 Copy

1.	Demirbas BT, Gulluoglu BM, Aktan AO. Retained abdominal gallstones after laparoscopic cholecystectomy: a systematic review. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 97-99.
2.	Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7): 1004-1021.
3.	何恒正, 周崢, 尹清華, 等. ERCP+LC和LC+LCBDE治療膽囊結石合并膽總管結石的效果比較. 實用醫學雜志, 2018, 34(11): 1889-1892.
4.	Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
5.	National Clinical Guideline Centre. Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis. London: National Institute for Health and Care Excellence (UK), 2014.
6.	Mohamed MA, Bahram MA, Ammar MS, et al. One-session laparoscopic management of combined common bile duct and gallbladder stones versus sequential ERCP followed by laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2015, 25(6): 482-485.
7.	Salama AF, Abd Ellatif ME, Abd Elaziz H, et al. Preliminary experience with laparoscopic common bile duct exploration. BMC Surg, 2017, 17(1): 32.
8.	Khaled YS, Malde DJ, de Souza C, et al. Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc, 2013, 27(11): 4164-4170.
9.	Bekheit M, Smith R, Ramsay G, et al. Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open, 2019, 3(3): 242-251.
10.	楊彥, 林師佈, 韓霖, 等. 腹腔鏡聯合膽道鏡膽總管探查一期縫合術洽療膽囊結石合并膽總管結石的臨床效果分析. 臨床肝膽病雜志, 2018, 34(3): 526-530.
11.	Hajibandeh S, Hajibandeh S, Sarma DR, et al. Laparoscopic transcystic versus transductal common bile duct exploration: a systematic review and meta-analysis. World J Surg, 2019, 43(8): 1935-1948.
12.	Gupta N. Role of laparoscopic common bile duct exploration in the management of choledocholithiasis. World J Gastrointest Surg, 2016, 8(5): 376-381.
13.	Lee JY, Keane MG, Pereira S. Diagnosis and treatment of gallstone disease. Practitioner, 2015, 259(1783): 15-19.
14.	Stoker ME, Leveillee RJ, McCann JCJR, et al. Laparoscopic common bile duct exploration. J Laparoendosc Surg, 1991, 1(5): 287-293.
15.	趙冬雨, 成麗婭, 于健. 膽囊結石繼發膽總管結石不同手術方式的臨床療效分析. 中國普外基礎與臨床雜志, 2014, 21(4): 498-500.
16.	魏留田, 趙高峰, 歐陽榮. 腹腔鏡下膽總管探查一期縫合術治療膽總管結石的臨床療效. 肝膽外科雜志, 2018, 26(3): 212-215.
17.	Darrien JH, Connor K, Janeczko A, et al. The surgical management of concomitant gallbladder and common bile duct stones. HPB Surg, 2015, 2015: 165068.
18.	Aawsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc, 2016, 30(6): 2563-2566.
19.	張磊, 宋曉靜, 周文策, 等. 十二指腸鏡、電子膽道鏡和腹腔鏡序貫治療膽總管結合合并膽囊結石834例臨床觀察. 臨床肝膽病雜志, 2014, 30(5): 428-430.
20.	Cai H, Sun D, Sun Y, et al. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg, 2012, 36(1): 164-170.
21.	Zhang WJ, Xu GF, Huang Q, et al. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg, 2015, 15: 7.
22.	Parra-Membrives P, Martínez-Baena D, Lorente-Herce J, et al. Comparative study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2018, 28(2): 145-151.
23.	梁廷波, 白雪莉, 陳偉. 腹腔鏡膽總管探查術治療膽總管結石的現狀與進展. 中華消化外科雜志, 2018, 17(1): 22-25.
24.	李留崢, 向春明, 徐雷升, 等. 腹腔鏡膽道探查取石術38例報道. 中國普外基礎與臨床雜志, 2015, 22(1): 23.
25.	Feng Q, Huang Y, Wang K, et al. Laparoscopic transcystic common bile duct exploration: advantages over laparoscopic choledochotomy. PLoS One, 2016, 11(9): e0162885.
26.	Pang L, Zhang Y, Wang Y, et al. Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysis. Surg Endosc, 2018, 32(11): 4363-4376.
27.	Reinders JS, Gouma DJ, Ubbink DT, et al. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg, 2014, 38(9): 2403-2411.
28.	Hanif F, Ahmed Z, Samie MA, et al. Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc, 2010, 24(7): 1552-1556.
29.	張明華, 劉瑞文, 陳健, 等. 腹腔鏡膽囊切除術中運用膽道鏡經膽囊管途徑治療膽總管結石. 肝膽胰外科雜志, 2016, 28(4): 319-321.
30.	Hongjun H, Yong J, Baoqiang W. Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutan Tech, 2015, 25(3): 218-222.
31.	Fang L, Wang J, Dai WC, et al. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc, 2018, 32(12): 4742-4748.
32.	潘步建, 徐邁宇, 陳峰, 等. 腹腔鏡下經膽囊管纖維膽道鏡取石術治療膽總管結石的臨床研究. 中華普通外科雜志, 2015, 30(6): 485-486.
33.	Lei J, Wang J, Li Q, et al. Laparoscopic transcystic common bile duct exploration: T-shaped incision of cystic duct with freddy laser lithotripsy. J Laparoendosc Adv Surg Tech A, 2016, 26(8): 646-651.

1. Demirbas BT, Gulluoglu BM, Aktan AO. Retained abdominal gallstones after laparoscopic cholecystectomy: a systematic review. Surg Laparosc Endosc Percutan Tech, 2015, 25(2): 97-99.
2. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones (CBDS). Gut, 2008, 57(7): 1004-1021.
3. 何恒正, 周崢, 尹清華, 等. ERCP+LC和LC+LCBDE治療膽囊結石合并膽總管結石的效果比較. 實用醫學雜志, 2018, 34(11): 1889-1892.
4. Ricci C, Pagano N, Taffurelli G, et al. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: a systematic review and network meta-analysis. JAMA Surg, 2018, 153(7): e181167.
5. National Clinical Guideline Centre. Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis. London: National Institute for Health and Care Excellence (UK), 2014.
6. Mohamed MA, Bahram MA, Ammar MS, et al. One-session laparoscopic management of combined common bile duct and gallbladder stones versus sequential ERCP followed by laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A, 2015, 25(6): 482-485.
7. Salama AF, Abd Ellatif ME, Abd Elaziz H, et al. Preliminary experience with laparoscopic common bile duct exploration. BMC Surg, 2017, 17(1): 32.
8. Khaled YS, Malde DJ, de Souza C, et al. Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc, 2013, 27(11): 4164-4170.
9. Bekheit M, Smith R, Ramsay G, et al. Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open, 2019, 3(3): 242-251.
10. 楊彥, 林師佈, 韓霖, 等. 腹腔鏡聯合膽道鏡膽總管探查一期縫合術洽療膽囊結石合并膽總管結石的臨床效果分析. 臨床肝膽病雜志, 2018, 34(3): 526-530.
11. Hajibandeh S, Hajibandeh S, Sarma DR, et al. Laparoscopic transcystic versus transductal common bile duct exploration: a systematic review and meta-analysis. World J Surg, 2019, 43(8): 1935-1948.
12. Gupta N. Role of laparoscopic common bile duct exploration in the management of choledocholithiasis. World J Gastrointest Surg, 2016, 8(5): 376-381.
13. Lee JY, Keane MG, Pereira S. Diagnosis and treatment of gallstone disease. Practitioner, 2015, 259(1783): 15-19.
14. Stoker ME, Leveillee RJ, McCann JCJR, et al. Laparoscopic common bile duct exploration. J Laparoendosc Surg, 1991, 1(5): 287-293.
15. 趙冬雨, 成麗婭, 于健. 膽囊結石繼發膽總管結石不同手術方式的臨床療效分析. 中國普外基礎與臨床雜志, 2014, 21(4): 498-500.
16. 魏留田, 趙高峰, 歐陽榮. 腹腔鏡下膽總管探查一期縫合術治療膽總管結石的臨床療效. 肝膽外科雜志, 2018, 26(3): 212-215.
17. Darrien JH, Connor K, Janeczko A, et al. The surgical management of concomitant gallbladder and common bile duct stones. HPB Surg, 2015, 2015: 165068.
18. Aawsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc, 2016, 30(6): 2563-2566.
19. 張磊, 宋曉靜, 周文策, 等. 十二指腸鏡、電子膽道鏡和腹腔鏡序貫治療膽總管結合合并膽囊結石834例臨床觀察. 臨床肝膽病雜志, 2014, 30(5): 428-430.
20. Cai H, Sun D, Sun Y, et al. Primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy. World J Surg, 2012, 36(1): 164-170.
21. Zhang WJ, Xu GF, Huang Q, et al. Treatment of gallbladder stone with common bile duct stones in the laparoscopic era. BMC Surg, 2015, 15: 7.
22. Parra-Membrives P, Martínez-Baena D, Lorente-Herce J, et al. Comparative study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech A, 2018, 28(2): 145-151.
23. 梁廷波, 白雪莉, 陳偉. 腹腔鏡膽總管探查術治療膽總管結石的現狀與進展. 中華消化外科雜志, 2018, 17(1): 22-25.
24. 李留崢, 向春明, 徐雷升, 等. 腹腔鏡膽道探查取石術38例報道. 中國普外基礎與臨床雜志, 2015, 22(1): 23.
25. Feng Q, Huang Y, Wang K, et al. Laparoscopic transcystic common bile duct exploration: advantages over laparoscopic choledochotomy. PLoS One, 2016, 11(9): e0162885.
26. Pang L, Zhang Y, Wang Y, et al. Transcystic versus traditional laparoscopic common bile duct exploration: its advantages and a meta-analysis. Surg Endosc, 2018, 32(11): 4363-4376.
27. Reinders JS, Gouma DJ, Ubbink DT, et al. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg, 2014, 38(9): 2403-2411.
28. Hanif F, Ahmed Z, Samie MA, et al. Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones. Surg Endosc, 2010, 24(7): 1552-1556.
29. 張明華, 劉瑞文, 陳健, 等. 腹腔鏡膽囊切除術中運用膽道鏡經膽囊管途徑治療膽總管結石. 肝膽胰外科雜志, 2016, 28(4): 319-321.
30. Hongjun H, Yong J, Baoqiang W. Laparoscopic common bile duct exploration: choledochotomy versus transcystic approach? Surg Laparosc Endosc Percutan Tech, 2015, 25(3): 218-222.
31. Fang L, Wang J, Dai WC, et al. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc, 2018, 32(12): 4742-4748.
32. 潘步建, 徐邁宇, 陳峰, 等. 腹腔鏡下經膽囊管纖維膽道鏡取石術治療膽總管結石的臨床研究. 中華普通外科雜志, 2015, 30(6): 485-486.
33. Lei J, Wang J, Li Q, et al. Laparoscopic transcystic common bile duct exploration: T-shaped incision of cystic duct with freddy laser lithotripsy. J Laparoendosc Adv Surg Tech A, 2016, 26(8): 646-651.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy analysis of primary closure with two or three endoscopes through cystic duct for treatment of gallbladder stone with secondary common bile duct stones

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