Strategies of minimally invasive treatment for intrahepatic and extrahepatic bile duct stones

doi:10.1007/s11684-017-0536-5

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 Author(s): 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:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0536-5
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I4/576

Study (year)	n	Surgery	Principal indications	Efficacy	Complications
Study (year)	n	Surgery	Principal indications	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
Study (year)	n	Surgery	Principal indications	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
Study (year)	n	Surgery	Principal indications	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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