Laparoscopic common bile duct exploration

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• 作者：Rosario Vecchio and Bruce V. MacFadyen
• 刊名：Langenbeck's Archives of Surgery
• 出版年：2002
• 出版时间：April 2002
• 年：2002
• 卷：387
• 期：1
• 页码：45-54
• 全文大小：83 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  General Surgery
  Abdominal Surgery
  Cardiac Surgery
  Thoracic Surgery
  Traumatic Surgery
  Vascular Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1435-2451

文摘

In recent years, laparoscoscopic common bile duct exploration has become the procedure of choice in the management of choledocholithiasis in several laparoscopic centers. The increasing interest for this laparoscopic approach is due to the development of instrumentation and technique, allowing the procedure to be performed safely, and it is also the result of the revised role of endoscopic retrograde cholangiopancreatography, which has been questioned because of its cost, risk of complications and effectiveness. Many surgeons, however, are still not familiar with this technique. In this article we discuss the technique and results of laparoscopic common bile duct exploration. Both the laparoscopic transcystic approach and choledochotomy are discussed, together with the results given in the literature. When one considers the costs, morbidity, mortality and the time required before the patient can return to work, it would appear that laparoscopic cholecystectomy with common bile duct exploration is more favorable than open surgery or laparoscopic cholecystectomy with preoperative or postoperative endoscopic sphincterotomy. However, the technique requires advanced laparoscopic skills, including suturing, knot tying, the use of a choledochoscope, guidewire, dilators and balloon stone extractor. Although laparoscopic common bile duct exploration appears to be the most cost-effective method to treat common bile duct stones, it should be emphasized that this procedure is very challenging, and it should be performed by well-trained laparoscopic surgeons with experience in biliary surgery.