Choledochotomy was performed using a standad 4 port technique - We used a 30 video- laparoscope - Factor required a high success rate in LCBDE: selection of the most correct p[r]
(1)DEPARTMENT OF SURGERY, BACH MAI HOSPITAL
EVALUATION OF LAPAROSCOPIC TREATMENT OF COMMON BILE DUCT STONES
INTRODUCTION
Transcystic duct: small stones small bile duct
Choledochotomy: large stones, large bile duct, intrahepatic stones
There’re two
(2)INTRODUCTION
- Việt Nam’ LCBDS: Choledochotomy is preferred - Depart of Surgery of Bach Mai: LCBDS 2006
The aim of this study:
The assessment of patient after LCBDE
PATIENTS AND METHODS
- Age > 15 y
- CBD stones, (single or multiple CBD stones) - MRI
- Plant operation
Inclusion criteria
316 P who underwen Lapa treatment of CBDS from 2006- Dec/ 2013)
- Complications of CBDS - Contraindication laparoscopic
(3)Symptoms n (%)
Pain under right abdomen 175 55.37
Fever ≥ 37.5 25 7.91
Jaundice 156 49.36
Hepato megali 68 21.51
Big gallbleder 136 43.03
Symptoms of Charcot”s 267 84.49
Symptoms and signs
Charcot 267 TH (84,49%)
RESULTS - DISCUSSION
Diagnosis Number of Patients
(%)
CBD stones 186 58.86
CBD stones + gallblader St 82 25.94 CBD stone + hepatic stones 35 11.07 CBD, Hepatic, gallblader St 13 4.1
(4)RESULTS - DISCUSSION
Numerous stones: stones
Placed stones : located below the cystic duct Size stones : > mm
RESULTS - DISCUSSION
(5)Operrative technique
RESULTS - DISCUSSION Operrative technique
(6)RESULTS - DISCUSSION
Tác giả CBD diameter
(mm)
Stones diameter (mm)
Gigot.J.F (1997) > > David.L (1999) > > 10 Ptelin.J.B (2003) > > Decker.G (2003) > > Puneet Gupta (2005) > 10 > Berthou.J.Ch (2007) > >
This report ≥ >7
Choledochtomy indication
A choledochtomy is indicated for large stones (>7mm), numerou stones, the stones are located abover the cystic duct
Viet Nam: large and multiple S, dilatation of the CBD→ choledochotomy is indicated
RESULTS - DISCUSSION
- The anterior aspect of CBD is cleared on a length of 10-20 mm
(7)Most authors prefer a longitudinal choledochotomy over a distance 10- 20 mm for removal stones
(8)RESULTS - DISCUSSION CBD close:
- The choledochotomy is closed with an absorbable running suture or interrupted vicryl 3.0
- In fact: Running suture faster interrupted
RESULTS - DISCUSSION
(9)Technique n (%)
Choledochotomy, primary closure 143 61.70
Chole,cholecystectomy, primary closure 68 21.51
Choledochotomy, T-tube 53 16.77
Chole, cholecystectomy, T- tube 30 0.94
Conversion to open 12 0.69
The main causes of failure:
- Subhepatic adhersion : patients - CBD stenosis : 3P - Perforation duodenal : P - Hemorrhage : P
Stones extraction by Laparoscopic choledochotomy was performed in 316 p With a success rate of 99 %with the first choledochotomy
RESULTS - DISCUSSION
Complications n Tỉ lệ(%)
Billiary peritonitis 0.68
Intra- abdominal hematoma 0.68
Subhepatic drain displacement 1.70
Bile leakage + intra abdominal abscess 1.02
Port infection 1.70
(10)RESULTS - DISCUSION
The length of postoperative stay was a shorter in the primary closure group compared with the T- tube
Primary closure:
Mean : 4.5 days Range : 3- days
2 T- tube
Mean : 8.8 days Range : 7- 14 days
(11)- LCBDS is safe and effective - Primary closure of CBD + Shorter operating times
+ Shorter length postoperative stay