Management of retained bile duct stone (s) after laparoscopic choleystectomy

Öz

Background/aims: Retained choledochal stones after laparoscopic cholecystectomy are still a major problem. The present study investigated the management of retained choledochal stones after laparoscopic cholecystectomy. Materials and methods: Among 226 consecutive patients who underwent laparoscopic cholecystectomy between 1998 and 2004, symptoms, and alanine aminotransferase, aspartate aminotransferase, bilirubin and alkaline phosphatase values of patients with suspected retained choledochal stone were evaluated. Diameter of choledochus was assessed by abdominal ultrasonography. Patients with suspected choledochal stone underwent endoscopic retrograde cholangiography and sphincterotomy. Results: Female to male ratio was 4:1 and median age was 58 years (range, 18-79 years). Elevated alanine aminotransferase values were detected in 16 patients suspected of retained choledochal stone among 23 patients who had been referred to the hospital between 7 days and 2 years following laparoscopic cholecystectomy. Stone extraction was performed in 11 of 12 patients with choledochal diameter of ≥10 mm and with high alanine aminotransferase and bilirubin levels via endoscopic retrograde cholangiography + endoscopic sphincterotomy. Choledochotomy + stone extraction was performed in 1 case via laparotomy. Conclusions: High alanine aminotransferase and choledochal diameter of ≥10 mm are important parameters for determination of choledochal stones, and endoscopic retrograde cholangiography + endoscopic sphincterotomy is a safe and feasible treatment modality.

Anahtar Kelimeler

• Laparoscopic cholecystectomy, retained choledochal stones, endoscopic sphincterotomy, endoscopic retrograde cholangiography, high alanine aminotransferase

Laparoskopik kolesistektomi sonrası kalıntı koledok taşı olgularının tanı ve tedavisi

Öz

Giriş ve amaç: Laparoskopik kolesistektomi sonrası kalıntı koledok taşlarının tanı ve tedavisi önemini korumaktadır. Bu çalışmada laparoskopik kolesistektomi sonrasında ortaya çıkan kalıntı koledok taşları nın tanı ve tedavisi incelenmiştir. Gereç ve yöntem: 1998-2004 yılları arasında ardışık olarak laparoskopik kolesistektomi ameliyatı uygulanan 226 hasta arasında kalıntı koledok taşından şüphelenilen 23 hastanın semptomları, kanda alanin transferaz, aspartat transferaz, bilirubin ve alkalen fosfataz değerleri kaydedildi. Ultrasonografi ile koledok çapı değerlendirildi. Kalıntı koledok taşı düşünülenlerde endoskopik retrograt kolanjiografi yapılarak taş saptananlarda sfinkterotomi yapıldı. Bulgular: Hastaların yaşları 18-79 yıl (ortanca 58 yıl), kadın erkek oranı 4:1'dir. Hastaların hastanede kalış süreleri 1-15 gün (ortalama 3 gün)'dür. Laparoskopik kolesistektomi sonrası biliyer semptomlarla 7 gün ile 2 yıl arasında yeniden hastaneye başvuran 23 (%10) ve koledok taşı düşünülen 16 olguda alanin transferaz değerleri yüksek bulundu. USG'de koledok çapı 10 mm ve üzerinde olan, alanin transferaz değerleri ve bilirubin düzeyleri yüksek olan 12 olgudan 11'ine endoskopik retrograd kolanjiografi+ endoskopik sfinkterotomi yoluyla taş ekstraksiyonu yapıldı. 1 olguya laparatomi yoluyla koledokotomi + taş ekstraksiyonu yapıldı. Sonuç: Alanin transferaz yüksekliği, koledok çapının 10 mm ve üzerinde olması kalıntı koledok taşlarının saptanmasında önemlidir ve tedavide endoskopik retrograd kolanjiografi ve endoskopik sfinkterotomi güvenilirdir.

Anahtar Kelimeler

• Laparoskopik kolesistektomi, kalıntı koledok taşı, endoskopik sfinkterotomi, endoskopik retrograd kolanjiografi, alanin transferaz yüksekliği

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