How is a bile duct stone removed?
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Treatment involves removal of the gallbladder as well as the gallstones from this tube. There are several methods to achieve this. Surgery is performed to remove the gallbladder. In the past, this was performed through a single large incision through the abdomen (open cholecystectomy). Newer keyhole techniques (laparoscopic surgery) are now the most common methods of removal of the gallbladder. Removal of the trapped gallstones in the common bile duct can be performed at the same time as the open or keyhole surgery. Alternatively, an endoscope (a narrow flexible tube equipped with a camera) is inserted through the mouth and into the small bowel to allow removal of the trapped gallstones from the common bile duct. This procedure can be performed before, during, and after the surgery to remove the gallbladder. This systematic review attempts to answer the question of the safest and most effective method to remove these trapped gallstones (in terms of open surgery or laparoscopic surgery compared with endoscopic removal), whether removal of the common bile duct stones should be performed during surgery to remove the gallbladder as a single-stage treatment or as a separate treatment before or after surgery (two-stage treatment). Show Review questions Quality of evidence Key results Authors' conclusions: Open bile duct surgery seems superior to ERCP in achieving common bile duct stone clearance based on the evidence available from the early endoscopy era. There is no significant difference in the mortality and morbidity between laparoscopic bile duct clearance and the endoscopic options. There is no significant reduction in the number of retained stones and failure rates in the laparoscopy groups compared with the pre-operative and intra-operative ERCP groups. There is no significant difference in the mortality, morbidity, retained stones, and failure rates between the single-stage laparoscopic bile duct clearance and two-stage endoscopic management. More randomised clinical trials without risks of systematic and random errors are necessary to confirm these findings. Read the full abstract... Background: Between 10% to 18% of people undergoing cholecystectomy for gallstones have common bile duct stones. Treatment of the bile duct stones can be conducted as open cholecystectomy plus open common bile duct exploration or laparoscopic cholecystectomy plus laparoscopic common bile duct exploration (LC + LCBDE) versus pre- or post-cholecystectomy endoscopic retrograde cholangiopancreatography (ERCP) in two stages, usually combined with either sphincterotomy (commonest) or sphincteroplasty (papillary dilatation) for common bile duct clearance. The benefits and harms of the different approaches are not known. Objectives: We aimed to systematically review the benefits and harms of different approaches to the management of common bile duct stones. Search strategy: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL, Issue 7 of 12, 2013) in The Cochrane Library, MEDLINE (1946 to August 2013), EMBASE (1974 to August 2013), and Science Citation Index Expanded (1900 to August 2013). Selection criteria: We included all randomised clinical trials which compared the results from open surgery versus endoscopic clearance and laparoscopic surgery versus endoscopic clearance for common bile duct stones. Data collection and analysis: Two review authors independently identified the trials for inclusion and independently extracted data. We calculated the odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) using both fixed-effect and random-effects models meta-analyses, performed with Review Manager 5. Main results: Sixteen randomised clinical trials with a total of 1758 randomised participants fulfilled the inclusion criteria of this review. Eight trials with 737 participants compared open surgical clearance with ERCP; five trials with 621 participants compared laparoscopic clearance with pre-operative ERCP; and two trials with 166 participants compared laparoscopic clearance with postoperative ERCP. One trial with 234 participants compared LCBDE with intra-operative ERCP. There were no trials of open or LCBDE versus ERCP in people without an intact gallbladder. All trials had a high risk of bias. There was no significant difference in the conversion rates of LCBDE to open surgery when compared with pre-operative, intra-operative, and postoperative ERCP groups. Meta-analysis of the outcomes duration of hospital stay, quality of life, and cost of the procedures could not be performed due to lack of data. How complicated is bile duct removal surgery?Usually part of the liver is removed, along with the bile duct, gallbladder, nearby lymph nodes, and sometimes part of the pancreas and small intestine. Then the surgeon connects the remaining ducts to the small intestine. This is a complex operation that can lead to life-threatening complications for some people.
What procedure is used to remove stone from bile duct?Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct. The gallbladder isn't removed during this procedure, so any stones in the gallbladder will remain unless they're removed using other surgical techniques.
How serious is stone in bile duct?Gallstones may also interfere with the flow of digestive fluids into the small intestine, leading to an inflammation of the pancreas, or pancreatitis. Prolonged blockage of any of these ducts can cause severe damage to the gallbladder, liver, or pancreas, which can be fatal.
Is a bile duct stone an emergency?People should not self-diagnose bile duct stones or delay care, as waiting longer to see a doctor increases the risk of serious complications, such as pancreatitis. Most people with bile duct stones will need to go to the emergency room.
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