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conferenceseries
.com
Volume 7, Issue 3 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
Gastro 2017
June 12-13, 2017
June 12-13, 2017 Rome, Italy
11
th
Global
GastroenterologistsMeeting
Recent advances in common bile duct stones management
Errawan R Wiradisuria
Indonesian Society of Endo-Laparoscopic Surgeons, Indonesia
S
ince laparoscopic cholecystectomy was done for the first time by Philippe Mouret (France, 1987), the development of minimally
invasive surgery in hepatobiliary system have been progressing, followed by Berci, Phillips (USA, 1991) who has done
laparoscopic common bile duct exploration (LCBDE) successfully later on. Abnormal intra operative cholangiogram, unsuccessful
attempts at endoscopic stone extraction for large/occluding stones, and intra hepatic stones are the indications for a LCBDE. While
contraindications for the procedure, such as inability of the surgeons to perform the necessary maneuvers, absent of indication,
instability of the patient, local condition in the porta hepatic made exploration hazardous, diameter of cystic duct less than 4 mm
(transcystic procedure) or diameter common bile duct (CBD) less than 6 mm (transcholedochal). Three major options inmanagement
of cholelithiasis with CBD stone were open cholecystectomy with CBD exploration, endoscopic sphincterotomy and stone extraction
followed by laparoscopic cholecystectomy (two stages) or laparoscopic cholecystectomy and laparoscopic CBD exploration done
in one stage. Choice of the treatment was based on patient safety consideration, time efficiency, and cost effectiveness. Surgeons’
competency becomes an important role to determine a successful LCBDE. Availability and preparedness of instruments/equipment
included Endoscopic Retrograde Cholangiopancreatography (ERCP) facilities are also the crucial supporting factors. LCBDE in
Jakarta was done from August 2004 to July 2016 with 44 cases. Mean age of the patients were 52 years. Mean operation time was
approximately 3.5 hours, with mean hospital stay about 5.5 days. Conversion of the operation was caused by impacted stones, massive
adhesion (anatomical reason) or instrument failures. Several complication or morbidity after the surgery included retained stone,
subphrenic abscess, T-tube insertion leakage, respiratory tract infection, urinary tract infection and superficial wound infection.
Recently, the LCBDE become an important alternative choice in treatment of CBD stone, especially in the failure of ERCP/endoscopic
stone extraction. LCBDE as a minimal invasive procedure has the advantages with high success rate, low morbidity and mortality rate
and faster post-operative period recovery. However, we still need more training and learning curve.
Biography
Errawan R Wiradisuria is the President of Indonesian Society of Endo-Laparoscopic Surgeons and Chairman of Advance Laparoscopic Surgery courses (Asia-
Pacific). He has published numerous papers in reputed journals and has been serving as an Editorial Board Member of repute.
errawan.w@gmail.comErrawan R Wiradisuria, J Gastrointest Dig Syst 2017, 7:3(Suppl)
DOI: 10.4172/2161-069X-C1-049