Operation method discussion of Stones at Common Bile Duct

Operation method discussion of Stones at Common Bile Duct

Stones at Common Bile Duct,Choledocholithiasis, is a common and frequently occurring disease in biliary tract surgery.

It accounts for 11% in stone disease of biliary system. Comparing with gallbladder stone, Choledocholithiasis attacks acutely with more serious symptoms and difficult therapeutic treatment. In some circumstance, choledocholithiasis can cause obstructive jaundice, cholangitis, cholangiogenic pancreatitis. If stone incarceration happens, acute pyogenic cholangitis may occur which could possibly lead to critical situation or even death.

Presently, there are three main methods to treat choledocholithiasis.

The first choice is open surgery. The principle and purpose of the operation is to clean the stone, solve the obstruction and prevent infection. Open surgery has high successful rate, but it is accompanied with disadvantages such as large trauma, long time recovery and more complications.

The second treatment is by laparoscopy operation. This operation develops later than open surgery and it requires physicians with skilled practice in laparoscope. This operation method is accompanied with larger risk if it is not done properly.

The novel operation method we are talking in this article is the papillary balloon dilation. It is a minimally invasive operation with good treatment effect, less trauma and fewer complications.

The other important point is that papillary balloon dilation shall only lead to the laceration of the papilla. Without cutting the papilla, the contraction function of papilla could be preserved.

It is likely that this method could replace most sphincterotomy and become the important method to treat choledocholithiasis.

Operational method:

Perform MRCP, or other image diagnosis to check the stone quantity and size in common bile duct.

Make preparation of ERCP and make contrast examination. Insert the guide wire through the contrast tube and remove the contrast tube

Choose dilation balloons with proper size according to the stone size. Insert the balloon dilation catheter through the guide wire. Watch the mark and place the middle of the balloon on the papilla. 1/3 of the balloon is suggested to be outside the papilla. Dilate the balloon.

During the dilation process, keep the catheter still to prevent the catheter enter into the depth of the bile duct. Use dilation pump to dilate the balloons. Follow the instructions of the ATM on the balloon label. When dilate the balloon to each stage, wait for around 40 seconds.

Retreat the guide wire and the balloon.

For stones with diameter less than 8mm, use stone retrieval basket and stone extraction catheter to remove the stone.

Forstones with diameter larger than 8mm, make lithotripsy and then remove the stones.

Make inspection by ultrasound in one week and check if the stones are cleaned completely.

Endoscopic papillary balloon dilation in the treatment of chledocholithiasis (Li Feng, Liu Xuchen, RenYanshun, et al. South Hospital of Tongchuan People’s Hospital in Shaanxi Province Tongchuan 727000)

According to the research made by South Hospital of Tongchuan People’s Hospital in Shaanxi Province, papillary balloon dilation could not avoid the complications completely. Pancreatitis and inflammation, bleeding and perforation may happen as well.

Pancreatitis is the most common complication due to the edema on the pancreas opening, repeated contrast in pancreatic duct, or movement of enteric bacteria during the operation process. An effective solution to prevent complication is to insert nasal biliary drainage tube after the stone retrieval operation. In the operation, please take care with the concentration of the contrast media and intubation times and technique

Bile duct inflammation could be lowered by antibacterial drugs before the operation.