Clinical effect of laparoscopic choledocholithotomy with direct stone removal through subxiphoid foramen
Yang Lei1, Xing Baoping1, Rong Chao1, Li Wei1, Ma Jing1, Tian Xingmeng2
1Department of General Surgery, Bengbu First People's Hospital, Bengbu 233000, China; 2Department of General Surgery, No.902 Hospital of the Joint Logistics Support Force PLA, Bengbu 233000, China
Abstract:Objective To explore the efficacy and surgical techniques of laparoscopic choledocholithotomy with direct stone removal through subxiphoid foramen.Methods The clinical data of 86 patients with choledocholithiasis who underwent laparoscopic choledocholithotomy through the subxiphoid foramen from November 2014 to April 2018 in Bengbu First People's Hospital were retrospectively analyzed. There were 28 males and 58 females aged 25-78(50.8±10.5) years. The operation time, intraoperative bleeding volume, time to get out of bed after operation, time to exhaust after operation, time to pull out drainage tube, hospital stay,postoperative complication and success rate of operation were observed according to the treatment.Results Laparoscopic surgery was successfully performed in 81 cases, with a success rate of 94.2%((81/86). One case was difficult to remove due to incarceration of terminal stones, and then was removed by choledochoscope. Among the other 5 cases, 1 case was converted to open surgery because of gallbladder duodenal leakage, and 4 cases were converted to open surgery because of the difficulty of separating triangular fibrosis after acute cholecystitis attack. The operation time was(80.2±18.6)min, intraoperative bleeding volume was (20.0±3.0)mL. The postoperative time of getting out of bed was (15.5±5.7)h, postoperative exhaust time was(30.2±10.2)h, time to pull out drainage tube was(2.4±0.4)d, and the postoperative hospitalization time was (10.4±2.6)d. T-tube was removed 4-6 weeks after operation. Eighty-one cases were followed up for 6 to 12 months, with an average of 8.5 months. No complications such as bile leakage, biliary stricture and recurrence of bile duct stones occurred after operation.Conclusions It is a safe,effective and feasible microtrauma surgery for treating choledocholithiasis underwent laparoscopic choledocho lithotomy via subxiphoid foramen. By choosing the appropriate patient, adjusting the position of the hole under xiphoid process and adjusting the operation details and improving the operation procedure, the operation time and trauma are reduced, and the stones can be removed completely.
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Yang Lei, Xing Baoping, Rong Chao, Li Wei, Ma Jing, Tian Xingmeng. Clinical effect of laparoscopic choledocholithotomy with direct stone removal through subxiphoid foramen. Chinese Journal of Anatomy and Clinics, 2020, 25(2): 176-179.
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