ObjectiveTo summarize the clinical experience on combination of laparoscopy, choledochoscopy, and duodenoscopy in treatment of cholecystolithiasis with small diameter of choledocholith during the same period via multiple approach. MethodsThe clinical data of 71 cases of cholecystolithiasis with small diameter(The internal diameter of common bile duct was 4-8 mm)of choledocholith underwent laparoscopic cholecystectomy(LC)plus laparoscopic and endoscopic cholelithotomy plus laparoscopic and endoscopic sphincterotomy(LC+LEC+LEST)from February 2001 to December 2013 in this hospital were analyzed retrospectively. Firstly, the LC and common bile duct exploration was performed, then the ureteral catheter or zebra guide wire was inserted into the common bile duct and duodenum cavity through cystic duct or common bile duct incision. Under the guidance of ureteral catheter or zebra guide wire, the choledochoscope was inserted into the common bile duct and cholelithotomy was performed by stone net or electrohydraulic lithotripsy. Then, the duodenoscope was inserted into the papillary of duodenum, the papillary of duodenum was cut by the pin-headlike electro-knife along the ureteric catheter or zebra guide wire, choledocholith was removed with the reticulation of choledochoscopy and duodenoscopy. ResultsLC+LEC+LEST was successfully performed on 71 cases of cholecystolithiasis with small diameter of choledocholith. The placement of a catheter via cystic incision was in 59 cases, via common bile duct incision was in 22 cases. The common bile duct stones of 64 patients were completely removed under the choledochoscope, of 12 patients were completely removed under the combination of choledochoscope and duodenoscope. No case was converted to laparotomy. The bile leakage occurred in 5 cases and cured by patent drainage. The slight pancreatitis occurred in one case after operation. There was no patient with residual stones, perforations of intestine and bile duct, hemorrhoea, severe pancreatitis, or death. ConclusionIf patients are indicated, LC+LEC+LEST is safe and effective to remove the cholecystolithiasis with small diameter of choledocholith.
ObjectiveTo summarize the experience of the transabdominal reverse guide technique of endoscopic nasobiliary drainage during the course of laparoscopic common bile duct exploration with endoscopic nasobiliary drainage (LENBD). MethodsFrom May 2008 to March 2015, there were 237 cases undergoing LENBD, involving choledochotomy, electrohydralic lithothipsy, incision on the stenosis of papillary, bile duct drainage through the endoscopic nasobiliary drainage, and primary closure of duct incision. ResultsEndoscopic nasobiliary drainage:the procedure were successful in 215 cases (90.7%) of nasobiliary drainage out of 237 cases. Nasal bile duct intubation failed in 6 cases (2.5%), wherein the transfered for ureteral catheter drainage of bile duct in 5 cases, bile duct drainage was given up in 1 cases. Nasobiliary discount caused no liquid outflow in 9 cases (3.8%). Nasal bile duct early slipped in 7 cases (3.0%). Primary closure of bile duct incision:the procedure were successful in 229 cases (96.6%) of primary closure out of 237 cases. Primary closure failed in 8 cases (3.4%) that the transfered for ureteral catheter drainage of bile duct in 5 cases (2.1%) and the bile leakage occurred in 3 cases (1.3%) with primary closure of duct incision and cured by patent drainage. Six cases (2.5%) were a slight pancreatitis after operation. Head of the nose bile duct was wrong to sew in 1 case (0.4%). No case residual stones in the biliary duct of 237 cases. No other serious complications and no case died postoperatively. ConclusionIf patients are suitable, transabdominal reverse guide technique in laparoscopic common bile duct exploration of endoscopic nasobiliary drainage is safe and effective in the hands of skilled endoscopists.
ObjectiveTo summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD). MethodsFrom April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision. ResultsThe procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation. ConclusionFrom preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.