This book provides a concise overview of several critically important techniques and their applications within Laparoscopic Common Bile Duct Exploration (LCBDE). LCBDE is rapidly emerging as the preferential management option for treating patients with common bile duct (CBD) stones. Chapters within this book describe how this technique can be applied to manage patients with concomitant gallstones, which aims to increase the exploration of the CBD via the transcystic route. Particular mention is made for the use of energy devices to enable stone fragmentation within the bile duct also known as Lithotripsy-Assisted Bile duct Exploration by Laparoendoscopy (LABEL). Guidance is also provided on how to set-up an acute biliary service which can offer the single-stage management of concomitant gallstones and choledocholithiasis. The concepts of 'Leveraging Access to Technology and Enhanced Surgical Techniques (LATEST)' in LCBDE and 'Biliary Surgery 2.0' as the framework through whichthese techniques can be further enhanced are analysed.

Laparoscopic Common Bile Duct Exploration features insight into how to perform these increasingly important procedures successfully and set-up a service within institutions that are yet to provide it. Therefore, it is a valuable resource for all medical professionals involved in the care of these patients.

Autorentext

Alberto Martinez Isla has been a consultant Upper GI Surgeon at London North West University Healthcare (LNWUH) NHS Trust and an Honorary Senior Lecturer at Imperial College London since 1997. He trained in gastrointestinal surgery in Madrid, Spain and in 1995 moved to the UK to work with Professor RCN Williamson at the Hammersmith Hospital and in 1997 was appointed permanent consultant at the current LNWUH NHS Trust. During his career he has done the whole range of Upper GI Surgery, and in the last 10 years his practice has been almost exclusively focused on hiatal and complex biliary surgery, especially laparoscopic bile duct exploration. He recently obtained a PhD in laparoscopic bile duct surgery. He has an academic pedigree with more than 100 peer reviewed publications.

Lalin Navaratne is currently a senior Specialist Registrar in General Surgery with a subspecialty interest in Upper GI Surgery. He graduated top of his class at UCL Medical School in 2010 and within one year gained membership to the Royal College of Surgeons in 2011. He is also a member of the regular British Armed Forces (Army Medical Services) with a background in Airborne Forces. He started his Core Surgical Training within the London Deanery in 2015 and then Higher Surgical Training within the London Deanery in 2017. His research interests within Laparoscopic Bile Duct Exploration (LBDE) include transcystic approach to the common bile duct, lithotripsy assisted bile duct exploration by laparoendoscopy and development of LBDE training models.

Hutan Ashrafian is a Clinical Lecturer in Surgery at Imperial College London. His research objectives are to develop innovative and technological strategies to resolve the global healthcare burden of obesity, metabolic syndrome, obesity-related cardiorespiratory disease, musculoskeletal dysfunction and cancer.

María Asunción Acosta-Mérida is Head of the Department of Esophagogastric, Endocrinometabolic, and Obesity Surgery at the University Hospital of Gran Canaria, Dr. Negrín, an expert in bariatric surgery, and a member of the multiple organ-harvesting team at her hospital. She is also a Professor of Digestive Surgery at the University of Las Palmas de Gran Canaria and a member of the Board of Esophagogastric and Minimally Invasive Surgery of the Spanish Association of Surgeons, as well as the Spanish Society for Obesity Surgery. M. Asunción also directs several national courses on bariatric and esophagogastric surgery and has authored scientific publications on various aspects of gastrointestinal surgery.

Stuart Andrews works as a Consultant Upper GI and General Surgeon within the South Devon Upper GI unit of Torbay District General Hospital, Devon, UK and also at the Mount Stuart Hospital, Torquay, Devon, UK, part of Ramsay Health Care International. He specialises in laparoscopic (keyhole) surgery related to Bariatrics (weight loss surgery), gallstones, hiatal disease (including acid reflux, para-oesophageal herniation and achalasia). He also specialises in open and laparoscopic abdominal wall hernias. Stuart Andrews was appointed as a Consultant Surgeon in Torbay Hospital in 2013. He graduated from St Andrew's University, Scotland in 1997 with a Degree in Medical Sciences and completed his clinical studies at Bristol University Medical School, graduating with MB ChB degree in 2000. Following completion of his basic surgical training in the UK, he was awarded member of the Royal College of Surgeons of England in 2003. After, he joined the Peninsula higher surgical training program in general surgery in South West England.

Kirk Bowling was originally from the South West of the UK. Studying for his medical degree in University Wales College of Medicine. He continued studying his passion for surgery in St Jude Hospital Memphis, USA before returning to the UK. After practising the discipline of surgery across most hospitals in the West of the UK he was appointed as one of the youngest Consultant Surgeons ever in the UK at Torbay Hospital where he has worked as a Consultant Surgeon in Benign Upper GI Surgery since 2017. He is currently the secretary of the British Benign Upper GI Society. He practises in bile duct exploration surgery and laparoscopic intraoperative ultrasound scanning on an unselected pool of biliary patients as part of his routine practice with excellent audited outcomes. David Martinez Cecilia graduated in Medicine and Surgery, Specialist in General Surgery and Digestive and Doctor of Medicine and Surgery from the University of Córdoba. He has extensive academic training, being an associate professor of Surgery at the University of Castilla la Mancha. He has completed training stays at prestigious centres in London, Toulouse and Southampton, among others. He has several years of experience in the field of abdominal surgery and obesity, with special dedication to laparoscopic surgery. It has been a pioneer in the application in our country of minimally invasive techniques and advanced procedures. He is also a member of the Spanish Association of Surgeons (AEC) and the Spanish Society for Surgery of Obesity and Metabolic Diseases (SECO), and actively collaborates with some of the most prestigious professionals and national centres for the treatment of obesity.

Inhalt

History of biliary surgery.-The first cholecystectomy.- The first choledochotomy.- History of common bile duct imaging.- Technique of CBD exploration in the 60's 70's.- The arrival of ERCP.- Approach to the cbd stones in the 80's.-The revolution in the nineties: The laparoscopic cholecystectomy and bile duct exploration.- Review of the evidence against and in favour of LC-IOC±LCBDE.- Our technique & equipment needed.- Equipment and kit needed for LCBDE.- Surgical technique for LCBDE.- Laparoscopic ultrasound.- Different surgical scenarios and its specific management.- Different surgical scenarios.- CBD and CD both non-dilated.- CD Dilated & CBD non-dilated.- CD non-dilated & CBD Dilated.- CD & CBD both dilated.- The impossible hilum: The transinfundibular approach.- The closure after the access to the CBD.- Closure over T -tube.- Closure over antegrade stent.- Primary closure.- Closure with transcystic drain.- Bilioenteric anastomoses.- The LABEL technique.- Our experience with LCBDE in more than 450 cases.- The evolution to Biliary Surgery 2.0.- Our cases.-Failure to clear the duct.- Morbidity.- Closure after exploring CBD.- T tube vs antegrade stent.-Primary closure.- Increase in the use of transcystic approach.- The transcystic vs the TD access.-management of Type II …