Historical Perspective on the Treatment of Choledocholithiasis: Lessons Learned and Techniques Prior to the Laparoscopic Era.- Current Understanding of Choledocholithiasis- Clinical Presentation and Pre-operative Evaluation.- Preoperative Decision-making Algorithm.- Intraoperative Ultrasound- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use.- Intraoperative Cholangiography- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use.- Laparoscopic Trans-cystic Exploration (Deciding who to Approach, Contraindications, Techniques- Cannulation, Dilation, Flouro-guided v. Choledochoscopy, Results, Complications, and Their Management.- Laparoscopic transcholedochal exploration (deciding who to approach, contraindications, technique of choledochotomy, instruments - catheters, scopes, etc., closure - primary v. t-tube v. internal drainage, results, complications and their management).- Stone fragmentation technologies and the approach to impacted stones (laser, mechanical lithotripsy, shock-wave, pneumatic and ultrasonic lithotriptors).- Adjuncts to common bile duct exploration (stents, drains, balloon dilation, antegrade sphincterotomy).- Open Common Bile Duct Exploration (indications/role in the modern era, technique, outcomes/complications).- Role of bilioenteric bypass in management of biliary stone disease (how to decide who needs this, technique, results/complications and management).- Endoscopic sphincterotomy for choledocholithiasis - preoperative v. postoperative, techniques, stone fragmentation for large stones, complications and management, outcomes, recent issues of infection with multi-drug resistant bacteria and implications).- Endoscopic ultrasound (EUS)- role in diagnosis and management of choledocholithiasis, transhepatic EUS approaches.- Laparoscopic-assisted ERCP (rendezvous procedures and transgastric ERCP).- Percutaneous techniques (transhepatic drainage).- Overcoming Institutional and Logistical Barriers to LCBDE.
This volume addresses the current lack of knowledge of many general surgeons and trainees in the comprehensive management of patients with choledocholithiasis, with an emphasis on how the surgeon can provide single-stage management for the majority of patients. It begins with a historical perspective on surgical techniques for laparoscopic common bile duct exploration (LCBDE) and reviews the knowledge and experience gained during the "open" era. Subsequent chapters cover preoperative evaluation, decision-making, and operative management, including intraoperative cholangiography, intraoperative ultrasound, laparoscopic and open common bile duct exploration, laparoscopic placement of biliary stents and other adjuncts, and laparoscopic bilio-enteric bypass. The volume also provides the reader with material on the full spectrum of options including chapters on endoscopic retrograde cholangiopancreatography and percutaneous approaches to the biliary tree. The chapters on individual procedures emphasize the technical aspects of the procedures, and include rich visual resources to guide the reader (illustrations, photographs, and videos to demonstrate typical cases and also challenging cases), as well as their outcomes and complication management. Finally, there is a discussion of how to identify and overcome logistical and institutional barriers to the adoption of LCBDE, and how simulation may be used to help teach the procedure.
Choledocholithiasis: Comprehensive Surgical Management will be of great value and utility to General Surgeons, Hepatobiliary Surgeons, Surgical Residents and Fellows, Endoscopists, and Interventional Radiologists.
B. Fernando Santos, MDAssistant Professor of SurgeryDepartment of SurgeryDartmouth College, Geisel School of MedicineVeterans Affairs Medical Center, White River Junction, VTWhite River Junction, VT
Nathaniel J. Soper, MDLoyal and Edith Davis Professor and Chair of Surgery. Northwestern Medicine. Surgeon-in-Chief, Northwestern Memorial Hospital