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Article ; Online: Laparoscopic retrograde appendicectomy with intracorporeal tie.

Zafar, N / Martínez-Isla, A / Navaratne, L

Annals of the Royal College of Surgeons of England

2022 Volume 104, Issue 9, Page(s) 719–720

MeSH term(s)	Humans ; Appendectomy ; Appendicitis/surgery ; Laparoscopy
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2021.0323
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Article ; Online: 10 years of laparoscopic common bile duct exploration: A single tertiary institution experience.

Navaratne, L / Martinez-Isla, A

American journal of surgery

2019 Volume 219, Issue 4, Page(s) 642–644

MeSH term(s)	Choledocholithiasis/surgery ; Common Bile Duct ; Humans ; Laparoscopy
Language	English
Publishing date	2019-04-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2019.04.009
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Article ; Online: Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases.

Navaratne, Lalin / Martinez Isla, Alberto

Surgical endoscopy

2020 Volume 35, Issue 1, Page(s) 437–448

Abstract: Background: Many studies have failed to demonstrate significant differences between single- and two-staged approaches for the management of choledocholithiasis with concomitant gallstones in terms of post-operative morbidity. However, none of these ... ...

Abstract	Background: Many studies have failed to demonstrate significant differences between single- and two-staged approaches for the management of choledocholithiasis with concomitant gallstones in terms of post-operative morbidity. However, none of these studies paid specific attention to the differences between the methods of accessing the bile duct during laparoscopy. The aim of this study was to report outcomes of transcystic versus transductal laparoscopic common bile duct exploration (LCBDE) from our experience of over four hundred cases. Methods: Retrospective review of 416 consecutive patients who underwent LCBDE at a single-centre between 1998 and 2018 was performed. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, intra-operative findings (including negative choledochoscopy rates, use of holmium laser lithotripsy and operative time) and post-operative outcomes. Results: Transductal LCBDE via choledochotomy was achieved in 242 patients (58.2%), whereas 174 patients (41.8%) underwent transcystic LCBDE. Stone clearance rates, conversion to open surgery and mortality were similar between the two groups. Overall morbidity as well as minor and major post-operative complications were significantly higher in the transductal group. The main surgery-related complications were bile leak (5.8% vs 1.1%, p = 0.0181) and pancreatitis (7.4% vs 0.6%, p = 0.0005). Median length of post-operative stay was also significantly greater in the transductal group. Conclusion: This study represents the largest single study to date comparing outcomes from transcystic and transductal LCBDE. Where possibly, the transcystic route should be used for LCBDE and this approach can be augmented with various techniques to increase successful stone clearance and reduce the need for choledochotomy.
MeSH term(s)	Biliary Tract Surgical Procedures/adverse effects ; Biliary Tract Surgical Procedures/methods ; Biliary Tract Surgical Procedures/mortality ; Cholangiography ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Cholecystectomy, Laparoscopic/mortality ; Choledocholithiasis/surgery ; Common Bile Duct/surgery ; Conversion to Open Surgery ; Gallstones/surgery ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Laparoscopy/mortality ; Lasers, Solid-State ; Lithotripsy, Laser ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/etiology ; Retrospective Studies ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2020-04-03
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-07522-7
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Article ; Online: Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy.

Al-Musawi, J / Navaratne, L / Martinez-Isla, A

American journal of surgery

2018 Volume 217, Issue 1, Page(s) 188–189

MeSH term(s)	Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Choledocholithiasis/surgery ; Common Bile Duct ; Delivery of Health Care, Integrated ; Humans
Language	English
Publishing date	2018-02-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.02.007
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Article ; Online: Leveraging access to technology and enhanced surgical technique (LATEST) in laparoscopic bile duct exploration (LBDE).

Navaratne, Lalin / Al-Musawi, Jasim / Vutipongsatorn, Kritchai / Isla, Alberto Martinez

Surgical endoscopy

2022 Volume 37, Issue 3, Page(s) 2367–2378

Abstract: Single-stage management of choledocholithiasis with concomitant gallstones consists of performing either laparoscopic bile duct exploration (LBDE) or intra-operative endoscopic retrograde cholangiopancreatography at the same time as laparoscopic ... ...

Abstract	Single-stage management of choledocholithiasis with concomitant gallstones consists of performing either laparoscopic bile duct exploration (LBDE) or intra-operative endoscopic retrograde cholangiopancreatography at the same time as laparoscopic cholecystectomy. Transductal LBDE is associated with significantly higher post-operative morbidity, longer operative times and longer hospital stay when compared to transcystic LBDE. The aim of this study was to report the transcystic exploration rate and post-operative outcomes from LBDE before and after implementation of the LATEST (Leveraging Access to Technology and Enhanced Surgical Technique) principles. Methods: A retrospective review of 481 consecutive patients between February 1998 and July 2021 was performed. Patients were assigned into two groups determined by whether they were operated before or after the implementation of LATEST. Data collected included pre-operative demographic information, medical co-morbidity, pre-operative investigations, and intra-operative findings (including transcystic exploration rate, negative choledochoscopy rate, use of holmium laser lithotripsy and operative time). Outcomes of this study were the transcystic exploration rate, stone clearance rate, conversion to open surgery, post-operative morbidity and mortality, and length of post-operative hospital stay. Results: The pre-LATEST group contained 237 patients and the LATEST group comprised of 244 patients. Ultra-thin choledochoscopes and holmium laser lithotripsy were used more frequently in the LATEST group (41.4% and 18.4%, respectively). Enhanced surgical techniques (correction of the cystic duct-CBD junction and the trans-infundibular approach) were also performed more frequently in the LATEST group. More patients in the LATEST group received transcystic LBDE (86.1% vs 11.0%, p < 0.0001). The LATEST group had significantly higher stone clearance rates (98.8% vs 93.7%, p = 0.0034), reduced post-operative morbidity and shorter post-operative hospital stay (4 days vs 1 day, p < 0.0001). Conclusions: LATEST describes four key factors that can be used when performing LBDE. The adoption of LATEST in LBDE is associated with an increased stone clearance, a higher transcystic exploration rate and reduced post-operative morbidity.
MeSH term(s)	Humans ; Holmium ; Laparoscopy/methods ; Choledocholithiasis/surgery ; Choledocholithiasis/complications ; Common Bile Duct/surgery ; Gallstones/surgery ; Cholecystectomy, Laparoscopic/methods ; Cholangiopancreatography, Endoscopic Retrograde ; Retrospective Studies ; Length of Stay
Chemical Substances	Holmium (W1XX32SQN1)
Language	English
Publishing date	2022-10-17
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09667-z
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Article ; Online: Comment on "Conventional Surgical Management of Bile Duct Stones: A Service Model and Outcomes of 1318 Laparoscopic Explorations".

Navaratne, Lalin / Al-Musawi, Jasim / Isla, Alberto Martinez

Annals of surgery

2021 Volume 274, Issue 6, Page(s) e901–e902

MeSH term(s)	Choledocholithiasis/surgery ; Gallstones/surgery ; Humans ; Laparoscopy ; Sphincterotomy, Endoscopic
Language	English
Publishing date	2021-05-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004951
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Article ; Online: Laparoscopic management of a migrated intragastric balloon causing mechanical small bowel obstruction: a case report and review of the literature.

Hay, D / Ryan, G / Somasundaram, M / Yip, V / Navaratne, L

Annals of the Royal College of Surgeons of England

2019 Volume 101, Issue 8, Page(s) e172–e177

Abstract: Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. ...

Abstract	Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A 26-year-old woman had an intragastric balloon placed endoscopically for weight control 13 months previously. She presented to the emergency department with a four-day history of intermittent abdominal cramps and vomiting. Contrast enhanced computed tomography confirmed the presence of the intragastric balloon within the small bowel. At laparoscopic retrieval, the deflated intragastric balloon was found impacted in the terminal ileum approximately 15 cm from the ileocaecal valve. The balloon was retrieved by enterotomy and primary closure of the ileum without event. The risk of balloon deflation and subsequent migration increases over time but several published cases demonstrate that this complication can occur within six months of insertion. The initial approach to the treatment of migrated intragastric balloons causing small bowel obstruction should be determined by the location of impaction, severity of obstruction and the available skill set of the attending radiologist, endoscopist and/or surgeon. Balloons causing obstruction in the duodenum are likely amenable to endoscopic retrieval whereas impaction within the jejunum or ileum could be managed by percutaneous needle aspiration (in selected cases), endoscopy (double-balloon enteroscopy), laparoscopy or open surgery.
MeSH term(s)	Adult ; Female ; Foreign-Body Migration/diagnostic imaging ; Foreign-Body Migration/etiology ; Foreign-Body Migration/surgery ; Gastric Balloon/adverse effects ; Humans ; Ileal Diseases/diagnostic imaging ; Ileal Diseases/etiology ; Ileal Diseases/surgery ; Intestinal Obstruction/diagnostic imaging ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Laparoscopy/methods ; Obesity/surgery ; Tomography, X-Ray Computed
Language	English
Publishing date	2019-09-06
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2019.0104
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Article ; Online: The ABCdE score for PREdicting Lithotripsy Assistance during transcystic Bile duct Exploration by Laparoendoscopy (PRE-LABEL).

Navaratne, Lalin / Martínez Cecilia, David / Martínez Isla, Alberto

Surgical endoscopy

2020 Volume 35, Issue 11, Page(s) 5971–5979

Abstract: Background: Common bile duct (CBD) stones are reported in ~ 15% of patients who undergo laparoscopic cholecystectomy for symptomatic gallstones. Prior to lithotripsy techniques, transcystic laparoscopic common bile duct exploration (LCBDE) was limited ... ...

Abstract	Background: Common bile duct (CBD) stones are reported in ~ 15% of patients who undergo laparoscopic cholecystectomy for symptomatic gallstones. Prior to lithotripsy techniques, transcystic laparoscopic common bile duct exploration (LCBDE) was limited to smaller CBD stones. The addition of lithotripsy to LCBDE increases cost, operative time and staffing requirements. Predicting which patients might require lithotripsy would be useful in operative planning. The primary aim was to investigate clinical variables for predicting lithotripsy assistance during transcystic bile duct exploration by laparoendoscopy (PRE-LABEL). Secondary aims were to develop and validate a predictive scoring tool. Methods: A retrospective review of a prospectively collected database of consecutive patients who underwent transcystic LCBDE at a single centre in the UK was performed to investigate clinical variables for PRE-LABEL and develop a scoring tool (ABCdE score: age, bilirubin, CBD diameter, ERCP). Binary logistic regression was used to investigate which independent variables (predictors) were associated with lithotripsy assistance during transcystic LCBDE. The ABCdE score was applied to both UK and Spain patient cohorts to determine its sensitivity, specificity and accuracy. Results: From 8 pre-operative clinical variables analysed, age ≤ 40 years, bilirubin > two-times upper limit of normal, CBD diameter ≥ 10 mm and ERCP failure of stone extraction were independent predictors of requiring lithotripsy during transcystic LCBDE and formed the ABCdE score. The hazard ratios were 2.87, 3.79, 2.78 and 10.06, respectively. An ABCdE score ≥ 2 resulted in 71% sensitivity, 81% specificity and 79% accuracy in predicting lithotripsy during LCBDE (UK cohort). Validation using a contemporary cohort from Spain yielded similar sensitivity, specificity and accuracy. Conclusions: This study represents the only study to date reporting independent predictors of requiring lithotripsy assistance during transcystic LCBDE. ABCdE score ≥ 2 can highlight patients that may require lithotripsy in order to avoid failure of transcystic LCBDE and therefore avoid choledochotomy or post-operative ERCP.
MeSH term(s)	Adult ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic/adverse effects ; Choledocholithiasis/surgery ; Common Bile Duct/diagnostic imaging ; Common Bile Duct/surgery ; Humans ; Laparoscopy ; Lithotripsy/adverse effects ; Retrospective Studies
Keywords	covid19
Language	English
Publishing date	2020-10-14
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-020-08082-6
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Article ; Online: Biliary Surgery 2.0.

Martínez-Cecilia, David / Navaratne, Lalin / Martínez Isla, Alberto

Cirugia espanola

2020 Volume 98, Issue 10, Page(s) 571–573

Title translation	Cirugía biliar 2.0.
Language	Spanish
Publishing date	2020-01-03
Publishing country	Spain
Document type	Editorial
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2019.12.003
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Article ; Online: Choledochal varices: An uncommon cholangioscopic finding.

Senra Lorenzana, Fátima / Navaratne, Lalin / Martínez Isla, Alberto

Cirugia espanola

2020 Volume 98, Issue 6, Page(s) 361

Title translation	Varices coledocianas: un hallazgo colangioscópico infrecuente.
MeSH term(s)	Aged ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/methods ; Choledocholithiasis/diagnostic imaging ; Choledocholithiasis/surgery ; Common Bile Duct/blood supply ; Common Bile Duct/pathology ; Cystic Duct/blood supply ; Cystic Duct/surgery ; Female ; Hemorrhage/therapy ; Humans ; Hypertension, Portal/complications ; Portal Vein/abnormalities ; Treatment Outcome ; Ultrasonography/methods ; Varicose Veins/diagnosis ; Varicose Veins/etiology
Language	Spanish
Publishing date	2020-02-17
Publishing country	Spain
Document type	Case Reports ; Video-Audio Media
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2019.12.010
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