BibTex RIS Kaynak Göster

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

Yıl 2007, Cilt: 6 Sayı: 2, 72 - 75, 01.08.2007

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.

Kaynakça

  • Olsen DO. Historical overview and indications for cholecystectomy: Laparoscopic surgery of the abdomen. 2004; Section II: 71-2.
  • Sarli L, Iusco DR, Roncoroni L, et al. Preoperative Endoscopic Sphincterotomy for the Management of Cholecystocholedocholithi- asis: 10-Year Experience. World J Surg 2003; 27: 180-6.
  • Frazee RC, Roberts J, Symmonds R, et al. Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithi- asis. Am J Surg 1993; 166: 702-6.
  • Sarli L, Pietra N, Franze A, et al. Routine intravenous cholangiog- raphy, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 1999; 50: 200-8.
  • Barkun JS, Fried GM, Barkun AN, et al. Cholecystectomy without operative cholanjiography. Ann Surg 1993; 218: 371-9.
  • Anwar S, Rahim R, Agwunobi A, et al. The role of ERCP in mana- gement of retained bile duct stones after laparoscopic cholecystec- tomy. J New Zeland Med Ass 2004; 117: 1-4.
  • Farrow GB, Dewan PA, Taylor RG, et al. Retained common-duct stones after open cholecystectomy and duct exploration in children. Pediatr Surg Int 2003; 19: 525-8.
  • Prat F, Pelletier G, Ponchon T, et al. What role can endoscopy play in the management of biliary complications after laparoscopic cho- lecystectomy? Endoscopy 1997; 29: 341-8.
  • Cuschieri A, Lezoche E, Morino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 1999; 13: 952-7.
  • Liu CL, Lai ECS, Lo CM, et al. Combined laparoscopic and endos- copic approach in patients with cholelithiasis and choledocholithi- asis. Surgery 1996; 119: 534-7.
  • Widdison AL, Longstaff AJ, Armstrong CP. Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: a pros- pective study. Br J Surg 1994; 81: 595-7.
  • Paganini AM, Guerrieri M, Sarnari J, et al. Long-term results after laparoscopic transverse choledochotomy for common bile duct sto- nes. Surg Endosc 2005; 19: 705-9.
  • Lilly MC, Arregui ME. A balanced approach to choledocholithiasis. Surg Endosc 2001; 15: 467-72.
  • Rhodes M, Sussman L, Cohen L, et al. Randomized trial of laparos- copic exploration of common bile duct versus postoperative endos- copic retrograde cholangiography for common bile duct stones. Lancet 1998; 351: 159-61.
  • Liu TH, Consorti ET, Kawashima A, et al. Patient evaluation and management with selective use of magnetic resonance cholangiog- raphy and endoscopic retrograde cholangiopancreatography befo- re laparoscopic cholecysytectomy. Ann Surg 2001; 243: 33-40.
  • Sahai AV, Mauldin PD, Marsi V, et al. Bile duct stones and laparos- copic cholecystectomy: a decision analysis to assess the roles of int- raoperative cholangiography, EUS, and ERCP. Gastrointest Endosc 1999; 49: 334-3.
  • Abu-Khalaf A. Endoscopic removal of retained common bile duct stones in patients with T tube in situ. Surg Laparosc Endosc 1995; 5: 17-20.
  • Phillips EH, Rosenthal RJ, Carroll BJ, et al. Laparoscopic trans- cystic-duct common-bile-duct exploration. Surg Endosc 1994; 8: 1389-93.
  • Voyles CR, Sanders DL, Hogan R. Common bile duct evaluation in the era of laparocopic cholecystectomy.1050 cases later. Ann Surg 1994; 219: 744-50.
  • Pitt HA. Role of open choledochotomy in the treatment of choledoc- holithiasis. Am J Surg 1993; 165: 483-6.

Laparoskopik kolesistektomi sonrası kalıntı koledok taşı olgularının tanı ve tedavisi

Yıl 2007, Cilt: 6 Sayı: 2, 72 - 75, 01.08.2007

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.

Kaynakça

  • Olsen DO. Historical overview and indications for cholecystectomy: Laparoscopic surgery of the abdomen. 2004; Section II: 71-2.
  • Sarli L, Iusco DR, Roncoroni L, et al. Preoperative Endoscopic Sphincterotomy for the Management of Cholecystocholedocholithi- asis: 10-Year Experience. World J Surg 2003; 27: 180-6.
  • Frazee RC, Roberts J, Symmonds R, et al. Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithi- asis. Am J Surg 1993; 166: 702-6.
  • Sarli L, Pietra N, Franze A, et al. Routine intravenous cholangiog- raphy, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 1999; 50: 200-8.
  • Barkun JS, Fried GM, Barkun AN, et al. Cholecystectomy without operative cholanjiography. Ann Surg 1993; 218: 371-9.
  • Anwar S, Rahim R, Agwunobi A, et al. The role of ERCP in mana- gement of retained bile duct stones after laparoscopic cholecystec- tomy. J New Zeland Med Ass 2004; 117: 1-4.
  • Farrow GB, Dewan PA, Taylor RG, et al. Retained common-duct stones after open cholecystectomy and duct exploration in children. Pediatr Surg Int 2003; 19: 525-8.
  • Prat F, Pelletier G, Ponchon T, et al. What role can endoscopy play in the management of biliary complications after laparoscopic cho- lecystectomy? Endoscopy 1997; 29: 341-8.
  • Cuschieri A, Lezoche E, Morino M, et al. E. A. E. S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 1999; 13: 952-7.
  • Liu CL, Lai ECS, Lo CM, et al. Combined laparoscopic and endos- copic approach in patients with cholelithiasis and choledocholithi- asis. Surgery 1996; 119: 534-7.
  • Widdison AL, Longstaff AJ, Armstrong CP. Combined laparoscopic and endoscopic treatment of gallstones and bile duct stones: a pros- pective study. Br J Surg 1994; 81: 595-7.
  • Paganini AM, Guerrieri M, Sarnari J, et al. Long-term results after laparoscopic transverse choledochotomy for common bile duct sto- nes. Surg Endosc 2005; 19: 705-9.
  • Lilly MC, Arregui ME. A balanced approach to choledocholithiasis. Surg Endosc 2001; 15: 467-72.
  • Rhodes M, Sussman L, Cohen L, et al. Randomized trial of laparos- copic exploration of common bile duct versus postoperative endos- copic retrograde cholangiography for common bile duct stones. Lancet 1998; 351: 159-61.
  • Liu TH, Consorti ET, Kawashima A, et al. Patient evaluation and management with selective use of magnetic resonance cholangiog- raphy and endoscopic retrograde cholangiopancreatography befo- re laparoscopic cholecysytectomy. Ann Surg 2001; 243: 33-40.
  • Sahai AV, Mauldin PD, Marsi V, et al. Bile duct stones and laparos- copic cholecystectomy: a decision analysis to assess the roles of int- raoperative cholangiography, EUS, and ERCP. Gastrointest Endosc 1999; 49: 334-3.
  • Abu-Khalaf A. Endoscopic removal of retained common bile duct stones in patients with T tube in situ. Surg Laparosc Endosc 1995; 5: 17-20.
  • Phillips EH, Rosenthal RJ, Carroll BJ, et al. Laparoscopic trans- cystic-duct common-bile-duct exploration. Surg Endosc 1994; 8: 1389-93.
  • Voyles CR, Sanders DL, Hogan R. Common bile duct evaluation in the era of laparocopic cholecystectomy.1050 cases later. Ann Surg 1994; 219: 744-50.
  • Pitt HA. Role of open choledochotomy in the treatment of choledoc- holithiasis. Am J Surg 1993; 165: 483-6.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Makaleler
Yazarlar

Mustafa Bozgül Bu kişi benim

Bekir Kuru Bu kişi benim

Mithat Çamlıbel Bu kişi benim

Yayımlanma Tarihi 1 Ağustos 2007
Yayımlandığı Sayı Yıl 2007 Cilt: 6 Sayı: 2

Kaynak Göster

APA Bozgül, M., Kuru, B., & Çamlıbel, M. (2007). Laparoskopik kolesistektomi sonrası kalıntı koledok taşı olgularının tanı ve tedavisi. Akademik Gastroenteroloji Dergisi, 6(2), 72-75.

test-5