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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (4) : 576-589    https://doi.org/10.1007/s11684-017-0536-5
COMMENTARY |
Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones
Zongming Zhang(), Zhuo Liu, Limin Liu, Mengmeng Song, Chong Zhang, Hongwei Yu, Baijiang Wan, Mingwen Zhu, Zixu Liu, Hai Deng, Haiming Yuan, Haiyan Yang, Wenping Wei, Yue Zhao
Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
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Abstract

Cholelithiasis is a kind of common and multiple diseases. In recent years, traditional laparotomy has been challenged by a minimally invasive surgery. Through literature review, the therapeutic method, effect, and complications of minimally invasive treatment of intrahepatic and extrahepatic bile duct stones by combining our practical experience were summarized as follows. (1) For intrahepatic bile duct stones, the operation may be selected by laparoscopic liver resection, laparoscopic common bile duct exploration (LCBDE), or percutaneous transhepatic cholangioscopy. (2) For concomitant gallstones and common bile duct stones, the surgical approach can be selected as follows: laparoscopic cholecystectomy (LC) combined with endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation, LC plus laparoscopic transcystic common bile duct exploration, LC plus LCBDE, and T-tube drainage or primary suture. (3) For concomitant intrahepatic and extrahepatic bile duct stones, laparoscopic liver resection, choledochoscopy through the hepatic duct orifice on the hepatectomy cross section, LCBDE, EST, and percutaneous transhepatic cholangioscopic lithotripsy could be used. According to the abovementioned principle, the minimally invasive treatment approach combined with the surgical technique and equipment condition will be significant in improving the therapeutic effect and avoiding the postoperative complications or hidden dangers of intrahepatic and extrahepatic bile duct stones.

Keywords laparoscopy      choledochoscopy      duodenoscopy      cholelithiasis      minimally invasive treatment     
Corresponding Authors: Zongming Zhang   
Just Accepted Date: 19 June 2017   Online First Date: 14 August 2017    Issue Date: 04 December 2017
 Cite this article:   
Zongming Zhang,Zhuo Liu,Limin Liu, et al. Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones[J]. Front. Med., 2017, 11(4): 576-589.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0536-5
http://academic.hep.com.cn/fmd/EN/Y2017/V11/I4/576
Study (year) n Surgery Principal indications Efficacy Complications
Item % Item %
Jin (2016) [ 2] 96 LLH Left IBDS with irreversible disease (biliary strictures, severe parenchymal fibrosis or atrophy) CR
ISCR
FSCR
RSR
ISCR
15.6
96.9
100
1.0
91.7
Bile leakage
Incision infection
IAFC
2.1
1.0
7.3
Ye (2015) [ 3] 46 LLHH Left IBDS CR
ISCR
FSCR
RSR
0
93.5
100
4.3
Bile leakage
Incision infection
IAFC
6.5
2.2
4.3
Ding (2015) [ 4] 49 LLH Left IBDS CR
ISCR
4.1
100
Bile leakage
Wound infection
4.1
2.0
Kim (2015) [ 5] 17 LAHH or LRPS or LIHDE Right IBDS with biliary stricture, impacted stones, liver atrophy CR
ISCR
FSCR
RSR
0
88.2
100
0
Bile leakage
IAFC
Wound infection
Pleural effusion
0
11.8
5.9
5.9
Ye (2015) [ 6] 37 LLHH Left hepatolithiasis CR
ISCR
FSCR
RSR
2.7
94.6
100
5.4
Bile leakage
IAFC
Incision infection
5.4
5.4
2.7
Tan (2015) [ 7] 37 LH (LLLS, LLHH, LRHH)+C Left or right IBDS ISCR
FSCR
RSR
83.8
94.6
10.8
Bile leakage
IAFC
Pleural effusion
8.1
10.8
18.9
41 LIHDE Left or right IBDS ISCR
FSCR
RSR
70.7
82.9
29.3
Bile leakage
IAFC
Acute pancreatitis
4.9
9.8
7.3
Namgoong (2014) [ 8] 37 LLHH Left?hepatolithiasis CR
ISCR
RSR
0
100
0
Bile leakage
Wound abscess
IAFC
0
5.4
5.4
Zhou (2013) [ 12] 44 LH (LLLS, LLHH, LRHH) Left or right IBDS CR
ISCR
FSCR
RSR
6.8
88.4
95.4
7.0
Bile leakage
Wound bleeding
Pleural effusion
11.4
2.3
0
Lai (2010) [ 13] 55
19
LLLS or LCBDE
LLLS
IBDS with bile ductal strictures or atrophy of the left lateral section of liver IBDS without bileductal strictures CR
ISCR
FSCR
RSR
7.3
100
100
0
Bile leakage
Bile leakage
IAFC
10.5
16.7
5.6
36 LCBDE ISCR
FSCR
RSR
86.1
91.7
8.3
Tu (2011) [ 16] 28 LLH+C Left or right hepatolithiasis CR
ISCR
FSCR
RSR
0
82.1
100
3.6
Bile leakage
Pleural effusion
7.1
7.1
Zhang (2008) [ 17] 28 LCBDE+C via CBD Left or right hepatolithiasis CR
ISCR
FSCR
1.6
12.7
88.9
Bile leakage 12.7
Machado (2008) [ 18] 1 LRHH Right IBDS CR
ISCR
0
100
Not mentioned
Cai (2007) [ 19] 30 LH (LLLS, LLHH, LRHH)+C Unilateral IBDS with irreversible disease (biliary strictures, severe parenchymal fibrosis or atrophy) CR
ISCR
FSCR
RSR
3.3
89.7
100
0
Bile leakage
Incision infection
3.4
3.4
Wang [ 20] (2016) 67 PTCSL Complicated hepatolithiasis ISCR
FSCR
RSR
41.8
85.1
9.0
Cholangitis
Hemobilia
Biliary stricture
9.0
0
1.5
51 PTCS Complicated hepatolithiasis ISCR
FSCR
RSR
45.1
70.6
21.6
Cholangitis
Hemobilia
Biliary stricture
3.9
0
0
Cannavale (2015) [ 21] 182 PTCS or PTCSL Difficult IBDS FSCR
RSR
100
24.7
Cholangitis
Major bleeding
Perforations of the CBD
10.4
1.6
0.5
Liu (2004) [ 22] 15 PTCS IBDS with biliary strictures and recurrent stones after the operation of bile duct operation ISCR
RSR
86.7
13.3
Hemobilia 0
Lu (2009) [ 23] 67 PTCS IBDS with biliary strictures and the history of bile duct operation ISCR 86.6 Cholangitis
Hemobilia
Drainage catheter migration
Rupture of the sinus tract
9.0
10.4
3.0
3.0
Wang (2014) [ 24] 81 PTCSL IBDS without parenchymal atrophy ISCR 82.7 Cholangitis
Hemobilia
Drainage catheter migration
8.6
3.7
3.7
Liu (2015) [ 25] 100 PTCSL IBDS without severe disease (parenchymal fibrosis or atrophy) ISCR 85.0 Cholangitis
Hemobilia
Drainage catheter migration
16.0
7.0
7.0
Tab.1  Principal indications, efficacy, and complications of MIS for IBDS
Study (year) n Surgery Principal indications Efficacy Complications
Item % Item %
Sahoo (2014) [ 41] 41 ERCP+LC (two stage) GBS and CBDS with CBDS diameter <12 mm, CBD mean diameter 12.6 mm ISCR 70.7 Pancreatitis 12.2
42 LC+LERP (one stage) GBS and CBDS with CBDS diameter <12 mm , CBD mean diameter 12.6 mm ISCR 90.5 Pancreatitis 0
Ding (2014) [ 42] 111 ERCP+LC (two stage, 2–5 days late) GBS and CBDS with CBD diameter >8 mm CR
ISCR
RSR
2.7
94.6
9.5
Bile leakage
Pancreatitis
Hemobilia
Wound infection
0
2.7
0.9
1.8
110 LC+LCBDE (one stage) GBS and CBDS withCBD diameter >8 mm CR
ISCR
RSR
0.9
93.6
2.1
Bile leakage
Pancreatitis
Hemobilia
Wound infection
1.8
0
0
1.8
Ghazal (2009) [ 43] 45 LC+IO-ERCP (one stage) GBS and CBDS with CBD normal or dilated CR
ISCR
2.2
100
Pancreatitis 0
Zhu (2014) [ 36] 111 LTCBDE CBDS with stone diameter <6 mm, stone number <3, CBD mean diameter 7.9 mm CR
RCBDS
19.8
1.8
Bile leakage 0
Shelat (2012) [ 44] 28
14
1
LTCBDE
LCBDE+T-tube
LCDDS
CBDS with CBD diameter>10 mm CR
ISCR
RCR
7.0
86.0
100
Bile leakage
Cholangitis
2.3
2.3
Dong (2014) [ 45] 101 LCBDE with primary closure CBDS with stone size >6 mm, stone number >3, CBD diameter >6 mm, cystic duct diameter <4 mm CR
ISRS
FSCR
CBD stricture
RSR
4.0
96.0
100
0
0
Bile leakage
Pancreatitis
Hemobilia
Pneumonia
Wound infection
5.0
1.0
1.0
1.0
1.0
93 LCBDE with T-tube drainage CBDS with stone size >6 mm, stone number >3, CBD diameter >6 mm, cystic duct diameter <4 mm CR
ISRS
FSCR
CBD stricture
RSR
3.2
96.8
100
0
0
Bile leakage
Pancreatitis
Hemobilia
Pneumonia
Wound infection
4.3
0
2.2
2.2
1.1
Zhang (2014) [ 46] 100 LCBDE with primary closure CBDS with CBD diameter >8 mm, cystic duct diameter <5 mm CR
ISRS
FSCR
CBD stricture
RSR
1.0
98.0
100
1.0
2.0
Bile leakage
Pancreatitis
2.0
0
92 LCBDE with T-tube drainage CBDS with CBD diameter <8 mm, cystic duct diameter <5 mm CR
ISRS
FSCR
CBD stricture
RSR
2.2
97.8
100
1.1
3.3
Bile leakage
Pancreatitis
1.1
0
DuCoin (2014) [ 47] 15 LCDDS CBDS after LRYGB, stone number >3, stone diameter >10 mm, failed PTSE CR 100 Bile leakage 6.7
ElGeidie (2011) [ 32] 111 LC+IO−ERCP (one stage) GBS and CBDS with CBD diameter 7.9 (7–18) mm, stone size 5.9 (4–25) mm, stone number 2.1 (1–6) CR
ISCR
FSCR
3.6
97.2
100
Bile leakage
Pancreatitis
Hemobilia
Wound infection
0.9
3.7
3.7
0.9
115 LC+LCBDE GBS and CBDS with CBD diameter 9.2 (6–20) mm, stone size 6.9 (4–30) mm, stone number 2.7 (1–5) CR
ISCR
FSCR
2.6
92.0
96.4
Bile leakage
Pancreatitis
Hemobilia
Wound infection
4.5
0.9
0.9
1.8
Chiarugi (2012) [ 48] 94 LC+LTCBDE CBDS and GBS with AC CR
ISRS
FSRS
Mortality
11.7
79.8
96.8
0
Bile leakage
Pancreatitis
Hemobilia
1.1
4.3
0
107 LC+LTCBDE CBDS and GBS CR
ISRS
FSRS
Mortality
4.7
84.1
97.2
0.9
Bile leakage
Pancreatitis
Hemobilia
5.6
4.7
0.9
Reinders (2014) [ 49] 401 ERCP CBDS CR
ISRS
Mortality
0–47.4
55.2–97.0
0–5.3
Bile leakage
Pancreatitis
Hemobilia
2.0
3.2
3.5
182 LTCBDE CBDS CR
ISRS
Mortality
0–19.6
80.4–100
0
Bile leakage 1.7
212 LCBDE CBDS CR
ISRS
Mortality
0–41.7
58.3–100
0–1.8
Bile leakage 10.9
Tab.2  Principal indications, efficacy, and complications of MIS for concomitant gallbladder and CBD stones
Study (year) n Surgery Principal indications Efficacy Complications
Item % Item %
Cannavale (2015) [ 21] 77 PTCSL+EST Difficult IBDS and CBDS FSCR
RSR
99.6
13.4
Cholangitis
Major bleeding
Perforations of the CBD
12.9
2.5
1.2
Li (2014) [ 57] 35 LLLS or LLHH+C via CBD CBDS and left IBDS with fibrosis or atrophy of the left lateral section of the liver CR
ISCR
FSCR
RSR
0
91.4
97.1
5.7
Bile leakage
Hemobilia
2.9
0
Chen (2014) [ 58] 45 LLLS or LLHH+C via CBD CBDS and left IBDS with fibrosis or atrophy of the left lateral section of the liver CR
ISCR
FSCR
RSR
0
95.6
100
0
Bile leakage
Hemobilia
4.4
0
Chen (2014) [ 59] 12 LALHH+C via CBD CBDS and left IBDS CR
ISCR
RSR
0
100
0
Bile leakage
Hemobilia
8.3
8.3
Tian (2013) [ 60] 116 LH+C via CBD or left or right LHD CBDS and IBDS with the history of biliary surgery CR
ISCR
FSCR
RSR
11.2
95.1
100
2.9
Bile leakage
Pleural effusion
Abdominal infection
Pulmonary infection
Incision infection
1.7
4.3
2.6
2.6
2.6
Hu (2013) [ 52] 23 LLLS or LLHH+C via LHD CBDS and left hepatolithiasis CR
RSR
2.4
0
Bile leakage 0
18 LLLS or LLHH+C via CBD CBDS and left hepatolithiasis CR
RSR
0
0
Bile leakage 5.6
Hu (2013) [ 61] 45 LLH+C via CBD CBDS and left IBDS with fibrosis or atrophy of the left lateral section of the liver CR
ISCR
0
100
Bile leakage
Hemobilia
8.9
0
Li (2013) [ 62] 35 LLLS or LLHH+C via CBD or LHD CBDS and left IBDS with fibrosis or atrophy of the left lateral section of the liver CR
ISCR
FSCR
RSR
0
91.4
97.1
5.7
Bile leakage
Hemobilia
2.9
0
Yoon (2009) [ 63] 46 LH (LLLS, LLHH)+C via CBD CBDS and IBDS with biliary stricture, impacted stones, liver atrophy CR
ISCR
FSCR
RSR
2.2
87.0
93.5
14.0
Bile leakage
IAFC
Pleural effusion
Death
13.0
4.3
13.0
2.2
30 LIHDE CBDS and IBDS with biliary stricture, impacted stones, liver atrophy CR
ISCR
FSCR
RSR
16.7
66.7
70.0
14.3
Bile leakage
IAFC
Wound infection
6.7
6.7
3.3
Yan (2012) [ 64] 31 LCBDE+C with FREDDY laser lithotripsy Difficult IBDS and CBDS without biliary strictures CR
ISCR
FSCR
RSR
0
93.5
100
0
Bile leakage
Hemobilia
0
0
24 LCBDE+C Difficult IBDS and CBDS without biliary strictures CR
ISCR
FSCR
RSR
12.5
79.2
100
0
Hemobilia
Bile leakage
4.2
0
Yan (2010) [ 65] 20 LCBDE+C with holmium laser lithotripsy IBDS and CBDS with the history of biliary surgery CR
ISCR
FSCR
RSR
0
90.0
100
0
Bile leakage
Hemobilia
0
0
Fang (2014) [ 56] 19 PTCSL with MI-3DVS IBDS and CBDS CR
ISCR
RSR
0
100
0
Bile leakage
Hemobilia
0
5.3
Tab.3  Principal indications, efficacy, and complications of MIS for concomitant IBDS with CBDS
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