Biliary lithiasis : basic science, current diagnosis, and management

The book provides an overview on biliary lithiasis and all its clinical pictures, twenty years after the first laparoscopic cholecystectomy. The gallbladder, the main bile duct and intra-hepatic stones, in their uncomplicated and complicated forms are illustrated. Chapters are focused on basic science, epidemiology, diagnostic and therapeutic approaches to biliary lithiasis. The different diagnostic procedures described include invasive and noninvasive imaging, and treatment options take into consideration medical treatment, open and minimally invasive surgery, endoscopic and percutaneous approaches, both individually and as combined procedures. The book's content is not limited to the most commonly used therapeutic approaches reported in the literature, but also addresses new and innovative therapeutic strategies for biliary lithiasis. Thanks to its comprehensive approach, this volume will be of interest not only for GPs amd specialists in this field, but also to residents and other health professional of different disciplines. Front Matter....Pages I-XVI Reflections on the Birth and on the Concept of Laparoscopic Surgery....Pages 1-11 Epidemiology of Biliary Lithiasis....Pages 13-18 Pathophysiology of Cholesterol Gallstone Disease....Pages 19-49 Classification, Composition and Structure of Gallstones. Relevance of these Parameters for Clinical Presentation and Treatment....Pages 51-65 Natural History of Biliary Lithiasis....Pages 67-74 Preoperative Noninvasive Imaging....Pages 75-92 Three-dimensional Imaging....Pages 93-103 Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound....Pages 105-113 Pre- and Intra-operative Diagnostic Fibrocholangioscopy....Pages 115-122 Intraoperative Cholangiography....Pages 123-129 Laparoscopic Ultrasound during Laparoscopic Cholecystectomy....Pages 131-141 Diagnostic Flow Charts for Biliary Lithiasis....Pages 143-148 Medical Treatment of Gallstone Disease....Pages 149-157 Surgical Treatment of Cholelithiasis: Exclusion Criteria....Pages 159-173 Anesthesia in Biliary Lithiasis....Pages 175-183 Cholecystectomy Techniques....Pages 185-207 Robot-assisted Cholecystectomy....Pages 209-216 Day Surgery Laparoscopic Cholecystectomy....Pages 217-236 Diagnosis and Treatment of Acute Cholecystitis....Pages 237-247 Incidental Carcinoma of the Gallbladder....Pages 249-253 Complications of Laparoscopic Cholecystectomy....Pages 255-309 Clinical Pictures of Common Bile Duct Stones....Pages 311-316 Synchronous Treatment of Common Bile Duct Stones by Laparotomy....Pages 317-323 Cholecystocholedocholithiasis: Two-stage Treatment....Pages 325-339 Synchronous Treatment of Common Bile Duct Stones by Laparoscopy....Pages 341-350 Rendez-vous Technique....Pages 351-356 Flow Chart for the Treatment of CBDS and Critical Comparison of Techniques....Pages 357-363 Common Bile Duct Stones in Cholecystectomized Patients....Pages 365-382 Acute Biliary Pancreatitis....Pages 383-392 Incidence and Management of Mirizzi Syndrome....Pages 393-400 Biliary Lithiasis in Children....Pages 401-408 Biliary Lithiasis in Pregnancy....Pages 409-413 Biliary Lithiasis and Obesity....Pages 415-424 Biliary Lithiasis in Patients with Gastroesophageal Reflux (Acid and Alkaline)....Pages 425-434 Hepatic Cirrhosis and Biliary Stones....Pages 435-438 Biliary Stones and Gastrectomy....Pages 439-447 Biliary Ileus....Pages 449-454 Clinical Pictures of Intrahepatic Lithiasis....Pages 455-465 Treatment of Intrahepatic Lithiasis....Pages 467-478 Extracorporeal Shock Wave Treatment of Gallbladder Stones....Pages 479-487 Shock Wave for Main Bile Duct Stones....Pages 489-495 Acute Gallstone Cholangitis: Clinical Pictures, Diagnosis and Treatment....Pages 497-508 Back Matter....Pages 509-513 The first laparoscopic cholecystectomy, performed by Prof. Philippe Mouret in 1987 and described by himself in the first chapter of this book, was an event that revolutionized surgery in the past few decades. Although the majority of surgeons today are unfamiliar with the his- ry of early minimally invasive surgery developments, it is important to realize that the advent of laparoscopy led not only to new surgical te- niques, but also to a change in the doctrine of medical care, by streng- ening the concept of minimal invasiveness. This is particularly the case for biliary lithiasis, for which laparoscopy has provided major benefits in terms of both diagnosis and surgical tre- ment. However, our understanding of the etiology of this disease, as well as the availability of effective medical therapies, have remained subst- tially unchanged over time. The application of the innovative approach has not been, in routine practice, without problems: between 1990 and 2000, the rate of serious complications from laparoscopic cholecystectomy were four times higher than those observed with open surgery. Even initial attempts at lapa- scopic treatment of biliary common bile duct stones resulted in excessive complications and associated medico-legal problems. Nonetheless, today, most indications have been stated, techniques have been standardized, and a new aspect to the treatment of biliary lithiasis has appeared. Offers an overview of biliary lithiasis and its clinical pictures. This work illustrates the gallbladder, the main bile duct and intra-hepatic stones, in their uncomplicated and complicated forms. It focuses on basic science, epidemiology, diagnostic and therapeutic approaches to biliary lithiasis