Ann Hepatobiliary Pancreat Surg.  2024 Feb;28(1):42-47. 10.14701/ahbps.23-085.

Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis: A preliminary Vietnamese study

• Le LV
• Vu QV
• Le TV
• Le HT
• Dang KK
• Vu TN
• Nguyen AHN
• Tran TM

• KMID: 2553364
• DOI: http://doi.org/10.14701/ahbps.23-085

Abstract

Backgrounds/Aims
Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients.
Methods
A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020.
Results
A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%.
Conclusions
Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

Keyword

Choledocholithiasis; Intrahepatic bile duct; Common bile duct; Laparoscopy; Choledochostomy

Figure

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  Fig. 1 Intraoperative findings: (A) the percutaneous-choledochal tube insert into the common bile duct easier with the stay sutures; (B) the tip of the percutaneous-choledochal tube can be rotated to the left or right to explore the left or right intrahepatic bile duct.

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  Fig. 2 Self-made percutaneous-choledochal tube. (A) Preparing. (B) Using it on a patient.

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  Fig. 3 Illustration of the percutaneous-choledochal channel.

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