Surgical Options for Retained Gallstones After Cholecystectomy.

IF 1.1 4区 医学 Q3 SURGERY
Ali Mohtashami, William A Ziaziaris, Chris S H Lim, Nazim Bhimani, Steven Leibman, Thomas J Hugh
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引用次数: 0

Abstract

Background: Retained gallstones are the most common cause of postcholecystectomy pain. They may be in a long remnant cystic duct (CD), the common bile duct (CBD), or within a remnant gallbladder (GB) post subtotal cholecystectomy. Although endoscopic management is often attempted, occasionally surgical clearance is required. Rates of preoperative surgery to remove stones in a remnant GB are rising due to the increased practice of subtotal cholecystectomy during a problematic laparoscopic cholecystectomy. This study aims to review the surgical management of symptomatic retained stones at a tertiary hepatobiliary referral center in Sydney, Australia.

Patients and methods: This retrospective analysis of prospectively collected data was performed on patients who underwent an operation for retained stones after a previous cholecystectomy over 18 years (2004-2022). All of the patients with residual CBD stones had failed endoscopic retrograde cholangiopancreatogram (ERCP) attempts or could not have an ERCP because of prior foregut surgery. All patients underwent a systematic preoperative workup confirming the biliary anatomy and pathology.

Results: Fourteen patients had surgical intervention for retained stones. All cases were attempted laparoscopically and were successful in 11/14 patients (78%). Retained stones were found within a remnant GB (29%, n=4), a remnant CD (36%, n=5), or the CBD (36%, n=5). Conversion to an open procedure in 3 patients was for dense fibrosis associated with a long low-insertion of the CD, necessitating a hepatico-jejunostomy, failure to delineate the biliary anatomy, and inability to clear CBD stones, respectively. One patient developed a minor postoperative complication (superficial wound infection), and all patients were free of symptoms at a median follow-up of 33.5 months.

Conclusion: This study demonstrates favorable outcomes in patients undergoing laparoscopic intervention for retained gallstones. A systematic approach to the workup and surgical management of patients with retained stones is essential.

胆囊切除术后胆结石残留的手术选择。
背景:胆结石残留是胆囊切除术后疼痛的最常见原因。胆结石可能位于长的残余胆囊管(CD)、总胆管(CBD)或胆囊次全切除术后的残余胆囊(GB)内。虽然经常尝试内镜治疗,但偶尔也需要手术清除。由于在有问题的腹腔镜胆囊切除术中越来越多地采用胆囊次全切除术,因此术前手术清除残余胆囊内结石的比例正在上升。本研究旨在回顾澳大利亚悉尼一家三级肝胆转诊中心对无症状残留结石的手术治疗:本研究对前瞻性收集的数据进行了回顾性分析,对象是在18年(2004-2022年)内接受过胆囊切除术后因结石残留而接受手术的患者。所有CBD残留结石患者都曾尝试过内镜逆行胰胆管造影术(ERCP)失败,或因之前的前肠手术而无法进行ERCP。所有患者都接受了系统的术前检查,确认了胆道解剖和病理情况:结果:14 名患者因结石滞留而接受了手术治疗。所有病例都尝试了腹腔镜手术,11/14 例患者(78%)手术成功。在残余GB(29%,n=4)、残余CD(36%,n=5)或CBD(36%,n=5)内发现了残留结石。3名患者转为开腹手术的原因分别是:CD低位插入过长导致纤维化致密,必须进行肝空肠造口术;胆道解剖结构不清晰;无法清除CBD结石。一名患者出现了轻微的术后并发症(浅表伤口感染),所有患者在中位随访33.5个月后均无症状:结论:这项研究表明,接受腹腔镜介入治疗的留置胆结石患者疗效良好。结论:这项研究表明,接受腹腔镜介入治疗的胆结石残留患者疗效良好。对胆结石残留患者进行系统的检查和手术治疗至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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