Takumi Yamaguchi, Satoru Takayama, Masaki Sakamoto, Ryohei Matsui, Toru Imagami. Nagoya Tokushukai General Hospital
AIMS:There are various approaches for the treatment of cholecystocholedocholithiasis. Laparoscopic cholecystectomy after endoscopic sphincterotomy (EST) is standard methodology now a day. However, compared with such metachronous strategy, simultaneous endoscopic sphincterotomy with cholecystectomy is favorable. And we usually perform it by rendezvous technique except for emergent case such as acute cholangitis. Additionally we also perform percutaneous and totally laparoscopic common bile duct exploration (LCBDE) therapy as options. We report such strategies suitable for each patient as follows.
METHODS: In case of rendezvous, laparoscopic operation starts with supine position after general anesthesia completed. After cystic duct is ligated, guide wire is inserted from the cystic duct then the endoscopic cannulation is done by using the wire from Papilla Vater. Finally the choledocholithiasis is cleared by EST. In case of percutaneous method, we use percutaneous endoscopic Laser lithotomy for instance such case as post-gastrectomy. And in cases of total laparoscopic method, we perform laparoscopic common bile duct explorations with primary common bile duct closure such case as huge stones.
RESULTS: We had no complications caused by these methodologies. Discussion: The results are worth comparing with standard approach. Our way, one-stage surgery is superior to reciprocal implementation of surgical and endoscopic procedures. Referring to the risk of iatrogenic damage, our ethodologies seems safer than standard treatment due to no pancreatic duct cannulation.
CONCLUSIONS: One-stage surgery and other option techniques showed favorable outcome. And we think we should perform each suitable strategy for each case.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79462
Program Number: P123
Presentation Session: Poster (Non CME)
Presentation Type: Poster