Full Description
This book provides a concise overview of several critically important techniques and their applications within Laparoscopic Common Bile Duct Exploration (LCBDE). LCBDE is rapidly emerging as the preferential management option for treating patients with common bile duct (CBD) stones. Chapters within this book describe how this technique can be applied to manage patients with concomitant gallstones, which aims to increase the exploration of the CBD via the transcystic route. Particular mention is made for the use of energy devices to enable stone fragmentation within the bile duct also known as Lithotripsy-Assisted Bile duct Exploration by Laparoendoscopy (LABEL). Guidance is also provided on how to set-up an acute biliary service which can offer the single-stage management of concomitant gallstones and choledocholithiasis. The concepts of 'Leveraging Access to Technology and Enhanced Surgical Techniques (LATEST)' in LCBDE and 'Biliary Surgery 2.0' as the framework through whichthese techniques can be further enhanced are analysed.
Laparoscopic Common Bile Duct Exploration features insight into how to perform these increasingly important procedures successfully and set-up a service within institutions that are yet to provide it. Therefore, it is a valuable resource for all medical professionals involved in the care of these patients.
Contents
History of biliary surgery.-The first cholecystectomy.- The first choledochotomy.- History of common bile duct imaging.- Technique of CBD exploration in the 60's 70's.- The arrival of ERCP.- Approach to the cbd stones in the 80's.-The revolution in the nineties: The laparoscopic cholecystectomy and bile duct exploration.- Review of the evidence against and in favour of LC-IOC±LCBDE.- Our technique & equipment needed.- Equipment and kit needed for LCBDE.- Surgical technique for LCBDE.- Laparoscopic ultrasound.- Different surgical scenarios and its specific management.- Different surgical scenarios.- CBD and CD both non-dilated.- CD Dilated & CBD non-dilated.- CD non-dilated & CBD Dilated.- CD & CBD both dilated.- The impossible hilum: The transinfundibular approach.- The closure after the access to the CBD.- Closure over T -tube.- Closure over antegrade stent.- Primary closure.- Closure with transcystic drain.- Bilioenteric anastomoses.- The LABEL technique.- Our experience with LCBDE in more than 450 cases.- The evolution to Biliary Surgery 2.0.- Our cases.-Failure to clear the duct.- Morbidity.- Closure after exploring CBD.- T tube vs antegrade stent.-Primary closure.- Increase in the use of transcystic approach.- The transcystic vs the TD access.-management of Type II Mirizzi syndrome.- The impact pf LCBDE in a general surgical department.-Bile duct exploration 2.0 .-Training in LCBDE.
