Suwatthanarak T, Chinswangwatanakul V, Methasate A, Phalanusitthepha C, Tanabe M, Akita K, Akaraviputh T. Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence. World J Gastrointest Endosc 2024; 16(6): 305-317 [PMID: 38946858 DOI: 10.4253/wjge.v16.i6.305]
Corresponding Author of This Article
Thawatchai Akaraviputh, MD, Professor, Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th floor, Siamindra Building, No. 2 Prannok Road, Bangkok Noi 10700, Bangkok, Thailand. thawatchai.aka@mahidol.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tharathorn Suwatthanarak, Vitoon Chinswangwatanakul, Asada Methasate, Chainarong Phalanusitthepha, Thawatchai Akaraviputh, Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
Tharathorn Suwatthanarak, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
Minoru Tanabe, Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
Keiichi Akita, Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
Author contributions: Suwatthanarak T and Akaraviputh T contributed to the conceptualization, the writing of the original draft; Chinswangwatanakul V, Methasate A, Phalanusithepha C, Akita K, and Tanabe M assisted with supervision; Suwatthanarak T, Phalanusithepha C, and Akaraviputh T were involved in visualization; Suwatthanarak T, Chinswangwatanakul V, Methasate A, Phalanusithepha C, Akita K, Tanabe M, and Akaraviputh T were involved in the review and editing. All authors have extensively examined and reached a consensus on the latest version of the published manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thawatchai Akaraviputh, MD, Professor, Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 12th floor, Siamindra Building, No. 2 Prannok Road, Bangkok Noi 10700, Bangkok, Thailand. thawatchai.aka@mahidol.ac.th
Received: April 5, 2024 Revised: May 7, 2024 Accepted: May 21, 2024 Published online: June 16, 2024 Processing time: 69 Days and 23.8 Hours
Abstract
While endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment modality for common bile duct stones (CBDS) or choledocholithiasis due to advancements in instruments, surgical intervention, known as common bile duct exploration (CBDE), is still necessary in cases of difficult CBDS, failed endoscopic treatment, or altered anatomy. Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes. This review elucidates relevant clinical anatomy, selection indications, and outcomes to enhance surgical understanding. The selection between trans-cystic (TC) vs trans-choledochal (TD) approaches is described, along with stone removal techniques and ductal closure. Detailed surgical techniques and strategies for both the TC and TD approaches, including instrument selection, is also provided. Additionally, this review comprehensively addresses operation-specific complications such as bile leakage, stricture, and entrapment, and focuses on preventive measures and treatment strategies. This review aims to optimize the management of CBDS through laparoscopic CBDE, with the goal of improving patient outcomes and minimizing risks.
Core Tip: Although the endoscopic-first approach is the most common for common bile duct stones (CBDS) treatment, surgical management remains crucial for subsequent cholecystectomy and additional CBDS removal in cases of failed endoscopy or surgical altered anatomy. Single-step common bile duct exploration offers non-inferior outcomes and may even advantageously reduce the number of hospital admissions. Proper selection between the trans-cystic and trans-choledochal approach is essential, and mastering both techniques through practice and rehearsal is necessary. Diligent attention to surgical anatomy and every step of the procedure can help prevent and reduce specific postoperative complications.
