Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence  

作　　者：Tharathorn Suwatthanarak Vitoon Chinswangwatanakul Asada Methasate Chainarong Phalanusitthepha Minoru Tanabe Keiichi Akita Thawatchai Akaraviputh 

机构地区：[1]Minimally Invasive Surgery Unit,Department of Surgery,Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok Noi 10700,Bangkok,Thailand [2]Graduate School of Medical and Dental Sciences,Tokyo Medical and Dental University,Bunkyo 113-8519,Tokyo,Japan [3]Department of Hepatobiliary and Pancreatic Surgery,Tokyo Medical and Dental University,Bunkyo 113-8519,Tokyo,Japan [4]Department of Clinical Anatomy,Tokyo Medical and Dental University,Bunkyo 113-8519,Tokyo,Japan

出　　处：《World Journal of Gastrointestinal Endoscopy》2024年第6期305-317,共13页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis 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.

关 键 词：CHOLEDOCHOLITHIASIS Common bile duct stone Difficult common bile duct stone Common bile duct exploration Laparoscopic common bile duct exploration 

分 类 号：R657.4[医药卫生—外科学]