Journal of Digestive Cancer Research

  • 제5권1호
  • /
  • Pages.37-43
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  • 2017
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  • 2950-9394(pISSN)
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  • 2950-9505(eISSN)
대한소화기암연구학회 (Korean Society of Gastrointestinal Cancer Research)
권호 표지

A Review of the Techniques, Current Status and Learning Curves of Laparoscopic Bile Duct Exploration

  • Poh Benjamin Ruimin (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital) ;
  • Tan Siong San (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital) ;
  • Lee Lip Seng (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital) ;
  • Chiow Adrian Kah Heng (Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital)
  • 투고 : 2016.11.30
  • 심사 : 2017.06.19
  • 발행 : 2017.06.30
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초록

Laparoscopic cholecystectomy is of one the most common general surgical operations performed today. Concomitant choledocholithiasis occurs in roughly 10-20% of patients with symptomatic gallstones. Laparoscopic bile duct exploration (LBDE) offers a single-stage minimally-invasive solution to the management of choledocholithiasis. LBDE may be performed either via the transcystic route or via laparoscopic choledochotomy. A number of strategies to improve success are available to the surgeon to help in the problem of complicated choledocholithiasis, these range from simple maneuvers to the use of laser or mechanical lithotriptors. With the advances in laparoscopic surgery, it is also possible to handle complex surgical conditions such as Mirizzi syndrome or recurrent pyogenic cholangitis laparoscopically, even though these have yet to be accepted as standard of care. Following laparoscopic choledochotomy, options for closure include: primary closure, closure over a T-tube, and closure over an endobiliary stent. T-tube placement has been associated with increased operating time and hospital length of stay compared to primary closure, with no significant differences in morbidity. Based on the available literature, LBDE appears comparable to ERCP with regards to procedural efficacy and morbidity. LBDE remains relevant to the general surgeon and is best viewed as being complementary to endoscopic therapy in the management of choledocholithiasis.

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참고문헌

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