Analysis of Efficacy and Safety of Laparoscopy plus Choledochoscopy Combined with Holmium Laser Lithotripsy for Choledocholithiasis and Hepatolithiasis
DOI:
https://doi.org/10.63682/jns.v13i1.8982Keywords:
Choledocholithiasis, Hepatolithiasis, Laparoscopy, Choledochoscopy, Holmium Laser Lithotripsy, Stone Clearance, Minimally Invasive SurgeryAbstract
Background:This study aimed to evaluate the efficacy and safety of laparoscopy combined with choledochoscopy-assisted holmium laser lithotripsy in managing biliary tract stones.
Methods:From March 2023 to March 2024, a prospective study was carried out on 71 patients suffering from choledocholithiasis and/or hepatolithiasis. Each patient received a laparoscopic common bile duct exploration with choledochoscopic visualization and holmium laser lithotripsy of stones. Information was gathered on patient age and sex, stone type and size, intraoperative and postoperative outcomes.
Results:Successful stone clearance was accomplished in 95.8% of cases, accompanied by negligible intraoperative complications (1.4%); low bile leakage rates (2.8%); and infrequent postoperative fever (7.0%). Conversion to open surgery was only required in 4.2% of patients. The average length of stay was 4.2 days. At 3-month follow-up, stone recurrence was noted in 2.8% of patients.
Conclusion:Laparoscopy combined with choledochoscopy and holmium laser lithotripsy is a highly effective and safe approach for managing biliary tract stones. It ensures optimal stone clearance with minimal complications and should be considered a valuable alternative to conventional methods in suitable candidates.
Downloads
References
Liu, B., et al., Comparison of efficacy and safety of laparoscopic holmium laser lithotripsy and laparoscopic bile duct exploration for bile duct stones: a systematic review and Meta-analysis. 2023. 47(7): p. 1809-1820.
Wang, P., et al., One-step percutaneous transhepatic cholangioscopic lithotripsy in patients with choledocholithiasis. 2021. 45(2): p. 101477.
Troncone, E., et al., Difficult biliary stones: a comprehensive review of new and old lithotripsy techniques. 2022. 58(1): p. 120.
Xiangdong, N., et al., Efficacy of laparoscopic choledochoscopy combined with holmium laser lithotripsy versus traditional laparotomy in treatment of bile duct stones: A Meta-analysis. 2023. 39(10): p. 2421-2431.
Sotirov, D., Laparoscopic Approach in the Case of Biliary Obstruction: Choledocholithiasis, in Current Concepts and Controversies in Laparoscopic Surgery. 2022, IntechOpen.
Zhu, T., et al., Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. 2021. 22(12): p. 985-1001.
Narula, V.K., et al., Clinical spotlight review for the management of choledocholithiasis. 2020. 34(4): p. 1482 - 1491.
Xia, H., et al., Surgical strategy for recurrent common bile duct stones: a 10-year experience of a single center. 2021. 73(4): p. 1399-1406.
Mao, W., et al., Surgical application of an implantable biliary access device in the treatment of refractory recurrent cholangiolithiasis. 2023. 13(5): p. 3333.
Jin, P., et al., Efficacy and safety of laparoscopic holmium laser lithotripsy in the treatment of complicated biliary calculus: A PRISMA-compliant systematic reviews and meta-analysis. 2019. 98(4): p. e14286.
Xia, H.-t., et al., A novel laparoscopic transcystic approach using an ultrathin choledochoscope and holmium laser lithotripsy in the management of cholecystocholedocholithiasis: an appraisal of their safety and efficacy. 2018. 215(4): p. 631-635.
Kedia, P. and P.R.J.G.E.C. Tarnasky, Endoscopic management of complex biliary stone disease. 2019. 29(2):
p. 257-275.
Hannah Schilperoort, M., M. Lynn Kysh, and M.J.G.E. Lea Matsuoka, ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. 2019. 89(6).
Alexander, C.M. and V.K. Narula, Management of pancreaticobiliary disease: endoscopic retrograde cholangiopancreatography (ERCP), in The SAGES manual of flexible endoscopy. 2019, Springer. p. 321-378.
He, M.-Y., et al., Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis: A systematic review and meta-analysis. 2018. 17(3): p. 183-191.
Parra-Membrives, P., et al., Comparative study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. 2018. 28(2): p. 145-151.
Lou, S.-m., et al., Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage. 2019. 20(11): p. 940-944.
Zerey, M., et al., Laparoscopic common bile duct exploration. 2018. 32(6): p. 2603-2612.
Qiu, S.-Y., et al., A successful combined laparoscopic cholecystectomy and laparoscopic exploration of common bile duct for acute gangrenous cholecystitis and choledocholithiasis during pregnancy: a case report. 2019. 58: p. 14-17.
Yao, C., et al., T‐tube‐free single‐incision laparoscopic common bile duct exploration plus cholecystectomy: a
single centre experience. 2019. 89(7-8): p. 895-899.
Guan, G., et al., Comparing a single-staged laparoscopic cholecystectomy with common bile duct exploration versus a two-staged endoscopic sphincterotomy followed by laparoscopic cholecystectomy. 2018. 164(5): p. 1030-1034....
Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

