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Springer Verlag, Journal of Hepato-Biliary-Pancreatic Sciences, 12(29), p. 1283-1291, 2022

DOI: 10.1002/jhbp.1123

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Multi‐institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

AbstractBackgroundRecently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single‐stage management of choledocholithiasis.MethodsA retrospective multi‐institutional study among 17 centers with proven experience in LBDE was performed. A cross‐sectional survey consisting of a semi‐structured pretested questionnaire was distributed covering the main aspects on the use of LBDE in the management of choledocholithiasis.ResultsA total of 3950 LBDEs were analyzed. The most frequent indication was jaundice (58.8%). LBDEs were performed after failed ERCP in 15.2%. The most common approach used was the transcystic (63.11%). The overall series failure rate of LBDE was 4% and the median rate for each center was 6% (IQR, 4.5‐12.5). Median operative time ranged between 60‐120 min (70.6%). Overall morbidity rate was 14.6%, with a postoperative bile leak and complications ≥3a rate of 4.5% and 2.5%, respectively. The operative time decreased with experience (P = .03) and length of hospital stay was longer in the presence of a biliary leak (P = .04). Current training of LBDE was defined as poor or very poor by 82.4%.ConclusionBased on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs.