Page 6 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Cholecystectomy and Common Bile

Duct Exploration Using Choledochotomy and Primary

Closure Following Failed Endoscopic Retrograde

Cholangiopancreatography: A Multicentric Comparative Study

Using Three-port vs Multiport

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Mauricio Pedraza-Ciro , Luis F Cabrera , Daniel A Gomez , Andres C Mendoza-Zuchini , Jean A Pulido , Maria C Jiménez ,
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Ricardo A Villarreal , Sebastian Sanchez-Ussa 8
AbstrAct
Background: Laparoscopic surgery has changed many ways in which we as surgeons manage patients, offering better results, quicker recovery,
and fewer complications using minimally invasive techniques, especially in common bile duct (CBD) surgery. Not only can laparoscopic techniques
be applied to programed surgery but also emergencies and those following failed endoscopic retrograde cholangiopancreatography (ERCP).
Objectives and aims: Describe and compare clinical and surgical results of the laparoscopic CBD exploration with primary closure using a
3-port vs multiport approach.
Materials and methods: We present a multicentric comparative study of 197 consecutive patients who underwent a laparoscopic gallbladder
removal along with CBD exploration with primary closure following failed (ERCP to extract CBD stones; 104 patients were managed by three-
port vs 93 multiport laparoscopic surgery in five centers of Bogotá, Colombia, between 2013 and 2017 with follow-up of 1 year.
Results: A total of 197 patients were taken to laparoscopic gallbladder removal along with CBD exploration with primary closure, 104 patients
via three-port technique and 93 patients via multiport. All (100%) the patients had previously failed ERCP. The average surgical time on the
three-port approach was 106 minutes vs 123 minutes on multiport. Only in the multiport technique we had an average conversion of 2%. Mean
hospital stay of 2.5 days, less for the three-port approach vs multiport in 5–7 days. There was a need of reintervention in 1% of the patients who
underwent three-port exploration.
Conclusion: Postoperative pain, use of an additional port, complication rates, operation time, and cost of the three-port technique were similar
to those of the conventional approach. Large randomized controlled trials are needed to examine the true benefits of the three-port technique.
Keywords: Common bile duct stones, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1392

IntroductIon 1,7 Department of Surgery, Universidad El Bosque, Bogota, Colombia
Laparoscopic cholecystectomy (LC) is seen as a gateway to 2 Department of Surgery, Universidad El Bosque, Bogota, Colombia;
minimally invasive surgery since the first operation was performed Department of Surgery, Fundación Santa Fe de Bogota, Bogota,
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in 1987 and reported in 1996. After this stimulating event, various Colombia
modifications of LC have been developed year by year, including 3 Department of Surgery, Centro Policlinico Olaya, Bogota, Colombia
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three-port, two-port, and single-port LC. In the era of laparoscopic 4 Department of Surgery, Universidad El Bosque, Bogota, Colombia;
surgery, the treatment of benign common bile duct (CBD) diseases Department of Surgery, Fundación Santa Fe de Bogota, Bogota, Colombia;
remains a topic of interest due to its surgical complexity. 3–5 Most Department of Surgery, Centro Policlinico Olaya, Bogota, Colombia
CBD interventions are done with open surgery or endoscopically 5,6 Department of Medicine, Universidad El Bosque, Bogota, Colombia
secondary to gallstone obstruction. With advances in surgical 8 Department of Surgery, Pontificia Universidad Javeriana, Bogota,
technique and instrumentation, CBD exploration using laparoscopy Colombia
has emerged as an attractive alternative offering a safe and cost- Corresponding Author: Mauricio Pedraza-Ciro, Department of Surgery,
effective option for CBD surgery 6–9 even in the emergency setting Universidad El Bosque, Bogota, Colombia, Phone: +57(301)3709557,
and following failed endoscopic treatment. 10,11 This series describes e-mail: mpedraza93@gmail.com
this three-port surgical technique for CBD exploration and primary How to cite this article: Pedraza-Ciro M, Cabrera LF, Gomez DA, et al.
closure as an alternative to conventional laparoscopy techniques Laparoscopic Cholecystectomy and Common Bile Duct Exploration Using
for this surgery. Choledochotomy and Primary Closure Following Failed Endoscopic
Retrograde Cholangiopancreatography: A Multicentric Comparative
MAterIAls And Methods Study Using Three-port vs Multiport. World J Lap Surg 2020;13(1):4–10.
Source of support: Nil

We performed a multicentric retrospective, descriptive, and
comparative study of laparoscopic common bile duct exploration Conflict of interest: None
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
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