ObjectiveTo summarize the experience of the transabdominal reverse guide technique of endoscopic nasobiliary drainage during the course of laparoscopic common bile duct exploration with endoscopic nasobiliary drainage (LENBD). MethodsFrom May 2008 to March 2015, there were 237 cases undergoing LENBD, involving choledochotomy, electrohydralic lithothipsy, incision on the stenosis of papillary, bile duct drainage through the endoscopic nasobiliary drainage, and primary closure of duct incision. ResultsEndoscopic nasobiliary drainage:the procedure were successful in 215 cases (90.7%) of nasobiliary drainage out of 237 cases. Nasal bile duct intubation failed in 6 cases (2.5%), wherein the transfered for ureteral catheter drainage of bile duct in 5 cases, bile duct drainage was given up in 1 cases. Nasobiliary discount caused no liquid outflow in 9 cases (3.8%). Nasal bile duct early slipped in 7 cases (3.0%). Primary closure of bile duct incision:the procedure were successful in 229 cases (96.6%) of primary closure out of 237 cases. Primary closure failed in 8 cases (3.4%) that the transfered for ureteral catheter drainage of bile duct in 5 cases (2.1%) and the bile leakage occurred in 3 cases (1.3%) with primary closure of duct incision and cured by patent drainage. Six cases (2.5%) were a slight pancreatitis after operation. Head of the nose bile duct was wrong to sew in 1 case (0.4%). No case residual stones in the biliary duct of 237 cases. No other serious complications and no case died postoperatively. ConclusionIf patients are suitable, transabdominal reverse guide technique in laparoscopic common bile duct exploration of endoscopic nasobiliary drainage is safe and effective in the hands of skilled endoscopists.
ObjectiveTo summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD). MethodsFrom April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision. ResultsThe procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation. ConclusionFrom preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.