Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 155] Primary close of choledoco and PCRE laparoscopic its better than classical PCRE by gastroenterologits
Juan Jose NUNEZ JU1, Fernando Byron SANTOS2, Ricardo Rodil Cruzalegui CRUZALEGUI1, Eduardo ANCHANTE CASTILLO1, Cecilia YEREN PAREDES1, Alejandro FUENTES1, Cristian ZETA ARICA1, Fernando Romulo REVOREDO REGO1, Frittz KOMMETTER1, Angela BASURCO1
1Department of Hepatobiliary and Pancreatic Surgery, Hospital Nacional Guillermo Almenara, Peru 2Department of Surgery, Assistant Professor of Surgery, Geisel School of Medicine, Dartmouth, United States
Background : In our country, of all patients who develop cholelithiasis, 15% developed choledocholithiasis during the development of the disease. Laparoscopic bile duct exploration can be performed through the transcystic and transcholedochal routes. Likewise, we use a device called a 3 mm choledochoscope, currently called Spyglass Discover from the Boston Scientific company. We also use biliary stents, catheters, dormia tubes, and balloon catheters to clean the bile duct from the intrahepatic ducts to the papilla or ampulla of Vatter.
Methods : We develop our practice by performing lap PCRE, which consists of: dissecting and cannulating the bile duct with a 3 mm choledochoscope, either through a transcystic or transcholedochal route and at the end we can perform a primary closure of the common bile duct, biliodigestive diversion or T-tube placement.
Results : We believe that if we have all the technological implements, skills in laparoscopic suturing and know the pathology and anatomy we can obtain better results than endoscopic retrograde cholangiopancreatography performed for more than 30 years by gastroenterologists and this examination, endoscopic retrograde cholangiopancreatography also called ERCP, has many many comorbidities and mortality: such as pancreatitis, perforation, bleeding and death that can occur in 1.5 to 2% of cases, that is, two people out of every 100 who can undergo PCRE or endoscopic retrograde cholangiopancreatography.
Conclusions : we present a novel method that can help us combat the most common choledocholithiasis in benign pathology and also study tumors, whether intrahepatic in the bifurcation of the liver or in the distal main bile duct. We are currently in the process of disseminating and teaching this new method, starting by teaching our surgeons how to manage the main bile duct and with simulation classes so that they can have all the technological weapons at hand to have the best results.
Methods : We develop our practice by performing lap PCRE, which consists of: dissecting and cannulating the bile duct with a 3 mm choledochoscope, either through a transcystic or transcholedochal route and at the end we can perform a primary closure of the common bile duct, biliodigestive diversion or T-tube placement.
Results : We believe that if we have all the technological implements, skills in laparoscopic suturing and know the pathology and anatomy we can obtain better results than endoscopic retrograde cholangiopancreatography performed for more than 30 years by gastroenterologists and this examination, endoscopic retrograde cholangiopancreatography also called ERCP, has many many comorbidities and mortality: such as pancreatitis, perforation, bleeding and death that can occur in 1.5 to 2% of cases, that is, two people out of every 100 who can undergo PCRE or endoscopic retrograde cholangiopancreatography.
Conclusions : we present a novel method that can help us combat the most common choledocholithiasis in benign pathology and also study tumors, whether intrahepatic in the bifurcation of the liver or in the distal main bile duct. We are currently in the process of disseminating and teaching this new method, starting by teaching our surgeons how to manage the main bile duct and with simulation classes so that they can have all the technological weapons at hand to have the best results.
SESSION
E-poster
E-Session 03/21 ALL DAY