151
|
Tracy BM, Valdez CL, Paterson CW, Hochman BR, Kwon E, Sims CA, Rattan R, Dante Yeh D, Gelbard RB. Broad vs Narrow Spectrum Antibiotics in Common Bile Duct Stones: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Study. J Am Coll Surg 2022; 235:411-419. [PMID: 35972159 DOI: 10.1097/xcs.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy. STUDY DESIGN We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI. RESULTS The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p < 0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02). CONCLUSION The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.
Collapse
Affiliation(s)
- Brett M Tracy
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Carrie L Valdez
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Cameron W Paterson
- Department of Surgery, Emory University School of Medicine, Atlanta, GA (Paterson)
| | - Beth R Hochman
- Department of Surgery, Columbia University Irving Medical Center, New York NY (Hochman)
| | - Eugenia Kwon
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA (Kwon)
| | - Carrie A Sims
- From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH (Tracy, Valdez, Sims)
| | - Rishi Rattan
- Department of Surgery, University of Miami, Miami, FL (Rattan, Yeh)
| | - D Dante Yeh
- Department of Surgery, University of Miami, Miami, FL (Rattan, Yeh)
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Gelbard)
| |
Collapse
|
152
|
Daliya P, Lobo DN, Parsons SL. Utilising Electronic PROMs to Measure a Change in Health Following Elective Laparoscopic Cholecystectomy: A Feasibility Study. World J Surg 2022; 46:2155-2165. [PMID: 35610385 PMCID: PMC9334410 DOI: 10.1007/s00268-022-06588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The collection of patient-reported outcome measures (PROMs) has many benefits for clinical practice. However, there are many barriers that prevent them from becoming a part of routine clinical care. The aim of this feasibility study was to pilot the use of a digital platform to facilitate the routine collection of pre- and post-operative electronic PROMs (ePROMs) in participants undergoing elective laparoscopic cholecystectomy and to validate the use of existing patient-reported outcomes for our population. METHODS Participants scheduled for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36). An assessment of methodological quality of ePROM questionnaires was also performed. RESULTS Preoperative ePROMs were completed by 200 participants undergoing laparoscopic cholecystectomy. Post-operatively attrition was high (completion at 30 days, 3 months, and 6months: n = 61, 54, and 38, respectively) due to difficulties accessing our ePROMs portal. Of those able to complete, a significant improvement in quality of life was seen across all health domains post-operatively when compared with baseline preoperative values for both disease-specific and generic PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires. CONCLUSION The collection of ePROMs is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality-of-life trends for clinicians, further developmental work is necessary to improve accessibility for patients, improve compliance, and reduce reporting bias from high attrition rates.
Collapse
Affiliation(s)
- Prita Daliya
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, , City Hospital Campus, Hucknall Road, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Simon L Parsons
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, , City Hospital Campus, Hucknall Road, Nottingham, UK
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| |
Collapse
|
153
|
Salman MA, Salman A, Mohamed US, Hussein AM, Ameen MA, Omar HSE, Elewa A, Hamdy A, Elias AAK, Tourky M, Helal A, Mahmoud AA, Aljarad F, Moustafa A, Shaaban HED, Nashaat A, Hussein AM, Omar T, Balamoun H. Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study. Surg Endosc 2022; 36:6396-6402. [PMID: 35020052 DOI: 10.1007/s00464-021-08980-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/31/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. METHODS This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. RESULTS Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months. CONCLUSION UDCA 500 mg once daily for 12 months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.
Collapse
Affiliation(s)
- Mohamed AbdAlla Salman
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Ahmed Salman
- Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Usama Shaker Mohamed
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mahmoud Hussein
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud A Ameen
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Haitham S E Omar
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Elewa
- Department of General Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Ahmed Hamdy
- Department of General Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Abd Al-Kareem Elias
- Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit branch, Assuit, Egypt
| | - Mohamed Tourky
- Great Western Hospital, NHS Foundation Trust, London, UK
| | - Alaa Helal
- Great Western Hospital, NHS Foundation Trust, London, UK
| | | | | | - Ahmed Moustafa
- Endemic Medicine and Hepatology Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hossam El-Din Shaaban
- Gastroentrology and Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | | | - Tamer Omar
- Department of General Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Hany Balamoun
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
154
|
Latenstein CSS, de Reuver PR. Tailoring diagnosis and treatment in symptomatic gallstone disease. Br J Surg 2022; 109:832-838. [PMID: 35640901 PMCID: PMC10364709 DOI: 10.1093/bjs/znac154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/24/2022] [Accepted: 04/25/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND There is a lack of consensus in selecting patients who do or do not benefit from surgery when patients present with abdominal pain and gallbladder stones are present. This review aimed to give an overview of results from recent trials and available literature to improve treatment decisions in patients with uncomplicated cholecystolithiasis. METHODS First, an overview of different symptom criteria for laparoscopic cholecystectomy in patients with uncomplicated cholecystolithiasis is given, based on national and international guidelines. Second, treatment outcomes (absence of biliary colic, pain-free state, biliary and surgical complications) are summarized, with data from three clinical trials. Finally, personal advice for treatment decisions in patients with uncomplicated cholecystolithiasis is provided, based on recent trials, the available literature, and expert opinion. RESULTS This review describes different guidelines and criteria sets for uncomplicated cholecystolithiasis, provides an overview of outcomes after cholecystectomy, and advises on treatment decisions in patients with abdominal pain and gallbladder stones. After cholecystectomy, biliary colic is resolved in 95 per cent of patients. However, non-specific abdominal pain persists in 40 per cent. Irritable bowel syndrome and functional dyspepsia significantly increase the risk of persistent pain. Age, previous abdominal surgery, baseline pain score on a visual analogue scale, pain characteristics, nausea, and heartburn are part of the SUCCESS criteria, and are associated with clinically relevant pain reduction after gallbladder removal. CONCLUSION The surgical community can now give more personalized advice on surgery to improve care for patients with abdominal pain and uncomplicated cholecystolithiasis.
Collapse
Affiliation(s)
| | - Philip R de Reuver
- Correspondence to: Philip R. de Reuver, Department of Surgery, RadboudUMC, PO Box 9101, 6500HB Nijmegen, the Netherlands (e-mail: )
| |
Collapse
|
155
|
Bozdag E, Sonmez S, Somuncu E, Yilmaz S, Basaran C, Bozkurt MA. Extrahepatic Biliary Tract Variations is an Effect for Acute Calculous Cholecystitis. J Coll Physicians Surg Pak 2022; 32:991-995. [PMID: 35932121 DOI: 10.29271/jcpsp.2022.08.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the anatomy of the extrahepatic bile duct and to reveal its importance in the formation of acute calculous cholecystitis (ACC). STUDY DESIGN Case-control study. PLACE AND DURATION OF STUDY Department of General Surgery and Radiology, Kanuni Sultan Suleyman Training and Research Hospital of the University of Health Sciences, Turkey, between January 2016 and December 2021. METHODOLOGY The data of the patients treated with ACC were analysed on MRCP by an experienced radiologist. The patients were divided into two groups; asymptomatic gallstones (AsGS, control group) and ACC. The cystic duct, common hepatic duct, and common bile duct lengths and variations in cystic duct opening were measured. Receiver operating characteristics (ROC) analysis was conducted to define a cut-off value and compared categorical results of the two groups by Mann-Whitney U test. RESULTS One-hundred and seventy-three patients were analysed, one-hundred and seven were females, and 66 were males. The median age was 46 years in the AsGS group and 53 years in the ACC group. It was statistically significant that ACC had a higher median age value than AsGS (p=0.014). In the analysis of extrahepatic variations, cystic duct, common hepatic duct, and common bile duct length, were statistically longer in the calculous cholecystitis group (p<0.001, p=0.022, and p=0.019 respectively). ROC analysis was performed for cystic, common hepatic, and common bile duct length, respectively. Cut-off values were 30.5 mm, 36.5 mm, and 42.5 mm. CONCLUSION Extrahepatic bile duct variations are of critical importance in ACC surgery. In the data, as the cystic duct and common bile duct lengthens, the possibility of ACC increases. There is need for studies with larger samples. KEY WORDS Acute calculous cholecystitis, Extrahepatic biliary tract, Anatomical variations, Cholelithiasis.
Collapse
Affiliation(s)
- Emre Bozdag
- Department of General Surgery, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| | - Suleyman Sonmez
- Department of Radiology, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| | - Erkan Somuncu
- Department of General Surgery, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| | - Serhan Yilmaz
- Department of General Surgery, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| | - Ceren Basaran
- Department of General Surgery, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, Kanuni Sultan Suleyman Training & Research Hospital, Health Science University, Istanbul, Turkey
| |
Collapse
|
156
|
Golzarand M, Toolabi K, Parsaei R, Eskandari Delfan S. Incidence of Symptomatic Cholelithiasis Following Laparoscopic Roux-en-Y Gastric Bypass Is Comparable to Laparoscopic Sleeve Gastrectomy: A Cohort Study. Dig Dis Sci 2022; 67:4188-4194. [PMID: 34783969 DOI: 10.1007/s10620-021-07306-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A few comparative studies have assessed the incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, they have shown inconsistent results. The present study has been designed based on comparing LSG and LRYGB regarding the incidence of symptomatic cholelithiasis and determining factors related to symptomatic cholelithiasis development after these procedures. METHODS This retrospective cohort study was conducted on 1163 patients aged ≥ 18 years old who underwent LRYGB (n = 377) or LSG (n = 786) from July 2006 to November 2019. The participants had no previous history of gallstones. A Cox-proportional hazard regression was used to assess associations between the types of procedures and the risk of symptomatic cholelithiasis. The univariable and then multivariable analysis were used to reveal the predictors of symptomatic cholelithiasis. RESULTS The mean person-time follow-up was 34 months (95% CI: 32.2 to 36.1 months). The incidence of symptomatic cholelithiasis was 8.3% over the follow-up period. There was no significant association between the risk of symptomatic cholelithiasis development and the type of surgical procedure (HR: 1.35, 95% CI: 0.75 to 2.41). Females had a 2.3-fold higher risk of symptomatic cholelithiasis than males, according to the multivariable Cox regression (HR: 2.31, 95% CI: 1.23 to 4.33). In addition, there was an inverse association between the administration of UDCA and the incidence of symptomatic cholelithiasis (HR: 0.13, 95% CI: 0.01 to 0.99). Our findings indicated that age, baseline body mass index (BMI), percentage of weight loss (%WL) after three and six months following surgery, postoperative pregnancy, and obesity-related comorbidities did not predict the risk of symptomatic cholelithiasis. CONCLUSION The present study illustrates no significant differences between LRYGB and LSG regarding symptomatic cholelithiasis occurrence. Our findings indicate that administration of UDCA has a protective effect against symptomatic cholelithiasis while, female gender is the main predictor of symptomatic cholelithiasis.
Collapse
Affiliation(s)
- Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karamollah Toolabi
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., Tehran, Iran.
| | | | | |
Collapse
|
157
|
Hoozemans JB, Groen AK, de Brauw LM. [Laparoscopic cholecystolithotomy]. Ned Tijdschr Geneeskd 2022; 166:D6658. [PMID: 35899709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Laparoscopic cholecystectomy is the standard treatment for upper abdominal complaints in the presence of gallbladder stones. This operation is a mediocre solution since only 63 % of the operated patients the symptoms become symptom free after one year. The laparoscopic cholecystolithotomy is an alternative procedure for removal of gallstones while preserving the gallbladder. This technique is being performed in Asia, but not in Western countries. The technique seems promising in patients after a bariatric procedure. These patients have a temporarily increased incidence of gallbladder stones. Laparoscopic cholecystectomy is associated with a an increased complication rate in these patients. But also non bariatric patients with symptomatic gallbladder stones might benefit from a laparoscopic cholecystolithotomy.
Collapse
Affiliation(s)
| | - Albert K Groen
- Amsterdam UMC, afd. Vasculaire Geneeskunde en Systeembiologie, Amsterdam
| | | |
Collapse
|
158
|
Liu H, Pan W, Yan G, Li Z. A retrospective cohort study on the optimal interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Medicine (Baltimore) 2022; 101:e29728. [PMID: 35801791 PMCID: PMC9259109 DOI: 10.1097/md.0000000000029728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are the most important procedures for patients with choledocholithiasis and gallstones. Many studies recommend early LC after ERCP; however, there is still no consensus on the optimal interval between the two. The purpose of this study was to investigate the appropriate timing of LC after ERCP in patients with choledocholithiasis and cholecystolithiasis. We retrospectively reviewed all ERCPs in our institution from November 2014 to August 2021. All eligible 261 patients were divided into ERCP-LC1 (≤3 days), ERCP-LC2 (3-7 days), and ERCP-LC3 (>7 days). We also reviewed 90 patients with elective LC as the LC group. Procedures, treatment outcomes, and postoperative adverse events were evaluated. In a total of 1642 ERCPs, 261 eligible patients were divided into ERCP-LC1 (n = 102), ERCP-LC2 (n = 113), and ERCP-LC3 (n = 46). The ERCP-LC groups had no difference in operation time, postoperative adverse events, and open conversion rate with the LC group, but the total hospital stay and hospital stay after LC were longer than the LC group. There were no differences between the ERCP-LC groups in operation time, hospital stay after LC, open conversion rate, postoperative adverse events, and efficacy. However, LC within 7 days and even 3 days after ERCP had significant advantages in improvement in total length of stay and medical expenses. Furthermore, we also found an increased risk of gallbladder gangrene and perforation in LC >7 days after ERCP. LC within 7 days and even 3 days after ERCP is a safe, effective, and economical method for patients with choledocholithiasis and gallstones.
Collapse
Affiliation(s)
- Huan Liu
- Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, China
- * Correspondence: Huan Liu, Department of General Surgery, Zhongshan Hospital of Traditional Chinese Medicine, No. 3 Kangxin Rd., West District, Zhongshan City, Guangdong Province 528400, China (e-mail: )
| | - Wenjun Pan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Guoqiang Yan
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| | - Zhongmin Li
- Department of General Surgery, Liaoyang Central Hospital, China Medical University, Liaoyang City, Liaoning Province, China
| |
Collapse
|
159
|
Gómez D, Pedraza M, Cabrera LF, Mendoza Zuchini A, Arrieta G M, Aparicio BS, Pulido J. Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature. Cir Esp 2022; 100:404-409. [PMID: 35525486 DOI: 10.1016/j.cireng.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. METHODS We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. RESULTS 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. CONCLUSION Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.
Collapse
Affiliation(s)
- Daniel Gómez
- Departamento de Cirugía Laparoscópica Avanzada, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | | | | | - Manuel Arrieta G
- Cirugía General, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | | | - Jean Pulido
- Departamento de Medicina, Universidad El Bosque, Bogotá, Colombia
| |
Collapse
|
160
|
Nezami N, Latich I, Chockalingam A, Arici M, Lee J, Perez Lozada JCL, Schlachter T. Safety and feasibility of single use cholecystoscopy for guiding laser or mechanical cholelithotripsy, and mechanical cholelithotomy. Diagn Interv Radiol 2022; 28:352-358. [PMID: 35950279 PMCID: PMC9634924 DOI: 10.5152/dir.2022.20810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Patients with acute calculus cholecystitis and contraindications to cholecystectomy receive cholecystostomy drainage catheters, many of which remain in place until end of life. This study aims to assess safety, feasibility, and early clinical outcomes of percutaneous cholecystoscopy using the LithoVue endoscope, laser/mechanical cholelithotripsy, and mechanical cholelithotomy for management of symptomatic cholelithiasis. METHODS This was a single-institute retrospective analysis of 17 patients with acute calculus cholecystitis who had contraindications to cholecystectomy, underwent cholecystostomy catheter placement between 2015 and 2017, and stone removal between 2017 and 2018. The LithoVue 7.7- 9.5 F endoscope was used in combination with laser/mechanical cholelithotripsy, mechanical retrograde, and balloon-assisted anterograde cholelithotomy to remove gallstones and common bile duct stones. Surgical contraindications ranged from cardiopulmonary disease to morbid obesity to neoplastic processes. Timing and number of interventions, as well as technical and clinical successes, were assessed. RESULTS The median time interval from cholecystostomy catheter placement to cholelithotripsy was 58 days, after an average of 2 tube exchange procedures. Technical and clinical success were achieved in all patients (stone-free gallbladder and cholecystostomy tube removal). On average, three sessions of cholecystoscopy and laser and mechanical cholelithotripsy were required for complete gallstone extraction. The mean interval time between the first cholelithotripsy session and removal of cholecystostomy was 71.8±60.8 days. There were neither major nor minor procedure-related complications. CONCLUSION Percutaneous cholecystoscopy using the LithoVue endoscope, in combination with laser/ mechanical cholelithotripsy and mechanical cholelithotomy, is feasible, safe, well-tolerated, and was able to remove the cholecystostomy tube in the patients with contraindication to cholecystectomy.
Collapse
Affiliation(s)
- Nariman Nezami
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Georgia, USA; Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA
| | - Igor Latich
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Georgia, USA
| | - Arun Chockalingam
- Department of Surgery, Bassett Medical Center, Cooperstown, New York, USA; Department of Radiology, Mt. Auburn Hospital/Harvard Medical School, Massachusetts, USA
| | - Melih Arici
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA
| | - Jessica Lee
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA
| | - Juan Carlos L Perez Lozada
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA
| | - Todd Schlachter
- Division of Vascular and Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Connecticut, USA
| |
Collapse
|
161
|
Zhao H, Zhang J. Effect of Endoscopic Retrograde Cholangiopancreatography Lithotomy Combined with Laparoscopic Cholecystectomy on Pain and Prognosis of Patients with Gallstones and Extrahepatic Bile Duct Stones. Comput Intell Neurosci 2022; 2022:9450159. [PMID: 35795764 PMCID: PMC9252623 DOI: 10.1155/2022/9450159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
Objective The researchers aim to assess how endoscopic retrograde cholangiopancreatography lithotomy and laparoscopic cholecystectomy affected pain and prognosis in individuals with gallstones and extrahepatic bile duct stones. Methods Researchers studied 100 persons with gallstones and extrahepatic bile duct stones from January 2016 to August 2021. They were split into two groups: control and observation. The control group underwent open cholecystectomy + choledocholithotomy + T-tube drainage. There were ERCP + lithotomy + Laparoscopic cholecystectomy procedures conducted on the observation group of patients (LC). The operation time, incision size, and bleeding volume; stone clearance rate and stone recurrence rate; visual analogue scale (VAS); Eating time, exhaust time, out of bed activity time, and postoperative hospital stay; the two groups' difficulties were contrasted and studied. Results The observation group's operation duration was much longer than the control group's, and the incision size and bleeding volume were significantly reduced in the observation group. When it came to recurrence, there was a significant difference between the observation group (2.0%) and the control group (4.0%), even though stone clearance did not differ substantially (20.00%). The VAS scores 3 and 7 days after surgery were significantly different between the observation and control groups. The observation group's eating time, exhaustion, activity time, and postoperative hospital stay were much shorter than the control group's; complications occurred at a lower rate (20%) in the observation group than in the control group (34%). Conclusion When gallstones and extrahepatic bile-duct stones are removed using laparoscopic lithotomy and laparoscopic cystoscopy (LC), the operation indices are improved and the risk of recurrence of stones is reduced and reducing the occurrence of complications, all of which improve patient outcomes and deserve to be considered a clinical reference.
Collapse
Affiliation(s)
- Hui Zhao
- Department of Gastroenterology, Huzhou Central Hospital, Huzhou 313000, China
- Department of Gastroenterology, Affiliated Central Hospital Huzhou University, Huzhou 313000, China
| | - Jian Zhang
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Huzhou 313000, China
- Department of Hepatobiliary Surgery, Affiliated Central Hospital Huzhou University, Huzhou 313000, China
| |
Collapse
|
162
|
Johan Drott C, Sandblom G, Österberg J, Rogmark P, Enochsson L. [Swedish gallstone surgery during the covid-19 pandemic]. Lakartidningen 2022; 119:21230. [PMID: 35723571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The covid-19 pandemic has necessitated reallocation of health care resources. This has raised concerns about the risks associated with postponing surgery for benign conditions that are given low priority. Data from the population-based Swedish National Register for Gallstone Surgery (GallRiks) show that the total number of procedures carried out during the initial months of each wave of the pandemic decreased. This was followed by a moderate increase in the number of procedures performed for acute cholecystitis, biliary pancreatitis, and obstructive jaundice. The consequences of the delayed surgery in the community at large and how this has affected health-related quality of life for patients having their procedure postponed remain to be evaluated, but so far it does not seem to have caused a major impact on public health.
Collapse
Affiliation(s)
| | - Gabriel Sandblom
- docent, överläkare, institutionen för klinisk vetenskap och utbildning, Södersjukhuset, Karolinska institutet; kirurgkliniken, Södersjukhuset, Stockholm
| | - Johanna Österberg
- med dr, överläkare, kirurgkliniken, Mora; institutionen för klinisk vetenskap, intervention och teknologi (CLINTEC), Karolinska institutet
| | - Peder Rogmark
- med dr, överläkare, kirurgkliniken, Skånes universitetssjukhus; institutionen för klinisk vetenskap, Malmö, Lunds universitet
| | - Lars Enochsson
- professor, överläkare, institutionen för kirurgisk och perioperativ vetenskap, Umeå universitet; kirurgkliniken, Sunderby sjukhus, Luleå
| |
Collapse
|
163
|
Lu DY, Zhang J, Liu QL, Wang HG, Cui M. Different Surface Appearances Caused by Unbalanced Mn 2+ Accumulation in Gallstones Consisting of Cholesterol and CaCO 3 Obtained from a Patient After Cholecystectomy. Biol Trace Elem Res 2022; 200:2660-2666. [PMID: 34478061 DOI: 10.1007/s12011-021-02902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Gallstones were examined for 58 patients in Jilin, Jilin. It was found that gallstones from only one who suffered from cholecystectomy were composed of 20 spheroidal stones and they rarely exhibited three different types of surface appearances. Six representative powder samples were analyzed for gallstones compositions and Mn2+ using X-ray diffraction (XRD)/Infrared (IR) and electron spin resonance (ESR), respectively. The results suggested that all gallstones from this patient were identified by XRD to be gallstones consisting mainly of cholesterol and CaCO3 (GCCC). They rarely exhibited three different kinds of surface appearances corresponding to different concentration of trace Mn2+ in calcite (CMn2+/CCal): 18 dark/light brown spheres with smooth surfaces and CMn2+/CCal = 0-6 μg/g/%, a yellowish-brown huge sphere with a rougher surface and CMn2+/CCal = 30 μg/g/%, and an ashy sphere composed of tens of microspheres with the roughest surface and CMn2+/CCal = 60 μg/g/%. The difference in surface appearance showed significant association with CMn2+/CCal, and its increase made the gallstone's surface change from smooth to rough and to fade in color. The unbalanced and competitive Mn2+ accumulation could occur occasionally in individual stones owing to different affinities to Mn2+, resulting in the formation of a huge stone and an ashy sphere. These two aberrations caused by higher CMn2+/CCal played an important role in suppressing the crystalline growth of the majority of dark/light brown spheres. GCCC from a patient might have a prominent Mn2+ partitioning feature corresponding to different surface appearances.
Collapse
Affiliation(s)
- Da-Yong Lu
- Key Laboratory for Special Functional Materials in Jilin Provincial Universities, Jilin Institute of Chemical Technology, Jilin, 132022, China.
| | - Jin Zhang
- Key Laboratory for Special Functional Materials in Jilin Provincial Universities, Jilin Institute of Chemical Technology, Jilin, 132022, China
| | - Qiao-Li Liu
- Key Laboratory for Special Functional Materials in Jilin Provincial Universities, Jilin Institute of Chemical Technology, Jilin, 132022, China
| | - Hong-Guang Wang
- Digestive Center, Jilin City People's Hospital, Jilin, 132001, China.
| | - Meng Cui
- Key Laboratory for Special Functional Materials in Jilin Provincial Universities, Jilin Institute of Chemical Technology, Jilin, 132022, China
| |
Collapse
|
164
|
Zhang C, Yang YL. [Pay attention to endoscopic diagnosis and treatment for confluence disease of pancreaticobiliary ducts]. Zhonghua Yi Xue Za Zhi 2022; 102:1326-1329. [PMID: 35545576 DOI: 10.3760/cma.j.cn112137-20220112-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The confluence of pancreaticobiliary ducts refers to the area between the end of common bile duct, the opening of main pancreatic duct and duodenal papilla. Those confluence diseases of pancreaticobiliary ducts will cause obstruction of biliary and pancreatic outflow tract, cholestasis, pancreatic juice deposition or pancreaticobiliary reflux, and thus induce gallstones, cholangitis, pancreatitis and other diseases. Endoscopic ampullary sphincterotomy is an important way to treat biliary and pancreatic diseases, but the length of incision is determined by the anatomy of Oddi sphincter. The endoscopic approach aims to relieve biliary and pancreatic outflow tract obstruction and pancreatic biliary reflux, and avoid enterobiliary reflux.
Collapse
Affiliation(s)
- C Zhang
- Cholelithiasis Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120, China
| | - Y L Yang
- Cholelithiasis Center, Tongji University Affiliated Shanghai East Hospital, Shanghai 200120, China
| |
Collapse
|
165
|
Tintara S, Shah I, Yakah W, Ahmed A, Sorrento CS, Kandasamy C, Freedman SD, Kothari DJ, Sheth SG. Evaluating the accuracy of American Society for Gastrointestinal Endoscopy guidelines in patients with acute gallstone pancreatitis with choledocholithiasis. World J Gastroenterol 2022; 28:1692-1704. [PMID: 35581962 PMCID: PMC9048789 DOI: 10.3748/wjg.v28.i16.1692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute gallstone pancreatitis (AGP) is the most common cause of acute pancreatitis (AP) in the United States. Patients with AGP may also present with choledocholithiasis. In 2010, the American Society for Gastrointestinal Endoscopy (ASGE) suggested a management algorithm based on probability for choledocholithiasis, recommending additional imaging for patients at intermediate risk and endoscopic retrograde cholangiopancreatography (ERCP) for patients at high risk of choledocholithiasis. In 2019, the ASGE guidelines were updated using more specific criteria to categorize individuals at high risk for choledocholithiasis. Neither ASGE guideline has been studied in AGP to determine the probability of having choledocholithiasis.
AIM To determine compliance with ASGE guidelines, assess outcomes, and compare 2019 vs 2010 ASGE criteria for suspected choledocholithiasis in AGP.
METHODS We conducted a retrospective cohort study of 882 patients admitted with AP to a single tertiary care center from 2008-2018. AP was diagnosed using revised Atlanta criteria and AGP was defined as the presence of gallstones on imaging or with cholestatic pattern of liver injury in the absence of another cause. Patients with chronic pancreatitis and pancreatic malignancy were excluded as were those who went directly to cholecystectomy prior to assessment for choledocholithiasis. Patients were assigned low, intermediate or high risk based on ASGE guidelines. Our primary outcomes of interest were the proportion of patients in the intermediate risk group undergoing magnetic resonance cholangiopancreatography (MRCP) first and the proportion of patients in the high risk group undergoing ERCP directly without preceding imaging. Secondary outcomes of interest included outcome differences based on if guidelines were not adhered to. We then evaluated the diagnostic accuracy of 2019 in comparison to the 2010 ASGE criteria for patients with suspected choledocholithiasis. We performed the t test or Wilcoxon rank sum test, as appropriate, to analyze if there were outcome differences based on if guidelines were not adhered to. Kappa coefficients were calculated to measure the degree of agreement between pairs of variables.
RESULTS In this cohort, we identified 235 patients with AGP of which 79 patients were excluded as they went directly to surgery for cholecystectomy without prior MRCP or ERCP. Of the remaining 156 patients, 79 patients were categorized as intermediate risk and 77 patients were high risk for choledocholithiasis according to the 2010 ASGE guidelines. Among 79 intermediate risk patients, 54 (68%) underwent MRCP first whereas 25 patients (32%) went directly to ERCP. For the 54 patients with intermediate risk who had MRCP first, 36 patients had no choledocholithiasis while 18 patients had evidence of choledocholithiasis prompting ERCP. Of these patients, ERCP confirmed stone disease in 11 patients. Of the 25 intermediate risk patients who directly underwent ERCP, 18 patients had stone disease. One patient with a normal ERCP developed post ERCP pancreatitis. Patients undergoing MRCP in this group had a significantly longer length of stay (5.0 vs 4.0 d, P = 0.02). In the high risk group, 64 patients (83%) had ERCP without preceding imaging, of which, 53 patients had findings consistent with choledocholithiasis, of which 13 patients (17%) underwent MRCP before ERCP, all of which showed evidence of stone disease. Furthermore, all of these patients ultimately had an ERCP, of which 8 patients had evidence of stones and 5 had normal examination.
Our cohort also demonstrated that 58% of all 156 patients with AGP had confirmed choledocholithiasis (79% of the high risk group and 37% of the intermediate group when risk was assigned based on the 2010 ASGE guidelines). When the updated 2019 ASGE guidelines were applied instead of the original 2010 guidelines, there was moderate agreement between the 2010 and 2019 guidelines (kappa = 0.46, 95%CI: 0.34-0.58). Forty-two of 77 patients were still deemed to be high risk and 35 patients were downgraded to intermediate risk. Thirty-five patients who were originally assigned high risk were reclassified as intermediate risk. For these 35 patients, 26 patients had ERCP findings consistent with choledocholithiasis and 9 patients had a normal examination. Based on the 2019 criteria, 9/35 patients who were downgraded to intermediate risk had an unnecessary ERCP with normal findings (without a preceding MRCP).
CONCLUSION Two-thirds in intermediate risk and 83% in high risk group followed ASGE guidelines for choledocholithiasis. One intermediate-group patient with normal ERCP had post-ERCP AP, highlighting the risk of unnecessary procedures.
Collapse
Affiliation(s)
- Supisara Tintara
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Ishani Shah
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - William Yakah
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Awais Ahmed
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cristina S Sorrento
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cinthana Kandasamy
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Steven D Freedman
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Darshan J Kothari
- Division of Gastroenterology, Duke University Medical Center, Durham, NC 27710, United States
- Division of Gastroenterology, Durham VA Medical Center, Durham, NC 27705, United States
| | - Sunil G Sheth
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| |
Collapse
|
166
|
Schers HJ. [Prediction model for gallstones can support the general practitioner]. Ned Tijdschr Geneeskd 2022; 166:D6679. [PMID: 35499599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The management of gallstones in primary care is challenging. After diagnosis, the GP has to decide which symptomatic patients will profit from referral for surgery. This is complicated, as many patients will continue to have symptoms also after surgery. A prediction model can support the GP in giving a more personalized advice. The prediction model is based on outcome data from randomized trials. These data helps GPs to have the right conversation with patients by predicting the probability of persisting pain after surgery. GPs should be more cautious in case of young age, heartburn, low pain scores and a history of abdominal surgery.
Collapse
Affiliation(s)
- Henk J Schers
- Radboud Universitair Medisch Centrum, afd. Eerstelijnsgeneeskunde
| |
Collapse
|
167
|
Georgiou K, Sandblom G, Alexakis N, Enochsson L. Intraoperative cholangiography 2020: Quo vadis? A systematic review of the literature. Hepatobiliary Pancreat Dis Int 2022; 21:145-153. [PMID: 35031229 DOI: 10.1016/j.hbpd.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. DATA SOURCES A systematic literature search was conducted in 2020 to search for articles that contained the terms "bile duct injury", "critical view of safety", "bile duct imaging" or "retained stones" in combination with IOC. All identified references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. RESULTS The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. CONCLUSIONS IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
Collapse
Affiliation(s)
- Konstantinos Georgiou
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset, Stockholm 17177, SE, Sweden
| | - Nicholas Alexakis
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå 90187, SE, Sweden.
| |
Collapse
|
168
|
Jiang YB, Liang B, Zheng JJ, Yang CM, Zhang JY. [Laparoscopic Common Bile Duct Exploration for Treatment of Common Bile Duct Stones:Clinical Analysis of 158 Cases]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:286-289. [PMID: 35538764 DOI: 10.3881/j.issn.1000-503x.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.
Collapse
Affiliation(s)
- Yong-Bin Jiang
- Department of General Surgery,the Number One Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China
| | - Bin Liang
- Department of General Surgery,the Number One Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China
| | - Jiao-Jiao Zheng
- Department of General Surgery,the Number One Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China
| | - Chun-Mei Yang
- Department of General Surgery,the Number One Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China
| | - Jing-Yu Zhang
- Department of General Surgery,the Number One Hospital of Zhangjiakou,Zhangjiakou,Hebei 075000,China
| |
Collapse
|
169
|
Liao Y, Cai Q, Zhang X, Li F. Single-stage intraoperative ERCP combined with laparoscopic cholecystectomy versus preoperative ERCP Followed by laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis: A meta-analysis of randomized trials. Medicine (Baltimore) 2022; 101:e29002. [PMID: 35451394 PMCID: PMC8913127 DOI: 10.1097/md.0000000000029002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The optimal treatment strategy for cholecystocholedocholithiasis is still controversial. We conducted an up-to-date meta-analysis to compare the efficacy and safety of the intra- endoscopic retrograde cholangiopancreatography (ERCP) + LC procedure with the traditional pre-ERCP + laparoscopic cholecystectomy (LC) procedure in the management of cholecystocholedocholithiasis. METHODS We searched the PubMed, Embase, Cochrane Library, and Web of Science databases up to September 2020. Published randomized controlled trials comparing intra-ERCP + LC and pre-ERCP + LC were considered. This meta-analysis was performed by Review Manager Version 5.3, and outcomes were documented by pooled risk ratio (RR) and mean difference (MD) with 95% confidence intervals. RESULTS Eight studies with a total of 977 patients were included in this meta-analysis. There was no significant difference between the two groups regarding CBD stone clearance (RR = 1.03, P = .27), postoperative papilla bleeding (RR = 0.41, P = .13), postoperative cholangitis (RR = 0.87, P = .79), and operation conversion rate (RR = 0.71, P = .26). The length of hospital stay was shorter in the intra-ERCP + LC group (MD = -2.75, P < .05), and intra-ERCP + LC was associated with lower overall morbidity (RR = 0.54, P < .05), postoperative pancreatitis (RR = 0.29, P < .05) and cannulation failure rate (RR = 0.22, P < .05). CONCLUSIONS Intra-ERCP + LC was a safer approach for patients with cholecystocholedocholithiasis. It could facilitate intubation, shorten hospital stay, and lower postoperative complications, especially postoperative pancreatitis, and reduce stone residue and reduce the possibility of reoperation for stone removal.
Collapse
Affiliation(s)
- Yang Liao
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Qichen Cai
- Department of Hepatobiliary Surgery, Chengdu Second People's Hospital, Sichuan, China
| | - Xiaozhou Zhang
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Fugui Li
- Department of Hepatobiliary Surgery, Zigong First People's Hospital, Zigong, Sichuan, China
| |
Collapse
|
170
|
Akay T, Sari E. Identification of risk factors involved in recurrence after common bile duct stone removal with ERCP: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29037. [PMID: 35244085 PMCID: PMC8896433 DOI: 10.1097/md.0000000000029037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.
Collapse
Affiliation(s)
- Tamer Akay
- Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey
| | - Erdem Sari
- Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey
| |
Collapse
|
171
|
Waleed M, Hassaan Arif Maan M, Soban Arif Maan M, Arsalan Arshad M. Non-Resolving Perihepatic Abscess Following Spilled Gallstones Requiring Surgical Management. S D Med 2022; 75:120-122. [PMID: 35708577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholelithiasis and is among the most frequently done procedures in United States. Spillage of gallstones occurs in up to 30 percent of these procedures and is associated with rare but important complications including abscess formation. CASE DESCRIPTION We present a case of 44-year-old man with a peri-hepatic abscess developed three years after a laparoscopic cholecystectomy. Multiple percutaneous drainages and antibiotic courses had failed to provide a definitive resolution. CT scan showed signs of a developing abscess but no stones. A diagnostic laparoscopy was performed, and multiple retained stones were visualized. It was converted to open laparotomy and the abscess was drained along with resection of portions of liver and diaphragm. The patient remained vitally stable with no fever spikes following the procedure. DISCUSSION Spillage of gallstones should be seriously considered in all patients presenting with peri-hepatic abscess with a history of previous LC, even if the imaging studies do not provide evidence of stones. Percutaneous drainage and antibiotics may provide temporary relief, but a surgical intervention is often the definitive management.
Collapse
Affiliation(s)
- Muhammad Waleed
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | | | | | - Muhammad Arsalan Arshad
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| |
Collapse
|
172
|
Interventional Physician Branch of Chinese Medical Doctor Association. [Diagnosis and treatment standardizations on percutaneous transhepatic papillary balloon dilation for common bile duct stones]. Zhonghua Nei Ke Za Zhi 2022; 61:263-8. [PMID: 35263967 DOI: 10.3760/cma.j.cn112138-20210823-00578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Common bile duct (CBD) stone is a prevalent disease. As a novel treatment for CBD stone in China, percutaneous transhepatic papillary balloon dilation (PTPBD) has shown some advantages compared with other modalities. However, many components of the procedure remains unclear, including indications, contraindications, patient preparation, bile duct puncture, papillary dilation, imaging interpretation, and complication management.In order to standardize the clinic practice of PTPBD, Chinese College of Interventionalists organized a committee, including interventional radiologists, digestive physicians and general surgeons, and commissioned this criterion.
Collapse
|
173
|
Tanase A, Dhanda A, Cramp M, Streeter A, Aroori S. A UK survey on variation in the practice of management of choledocholithiasis and laparoscopic common bile duct exploration (ALiCE Survey). Surg Endosc 2022; 36:5882-5896. [PMID: 35146558 DOI: 10.1007/s00464-021-08983-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The practice of managing suspected/confirmed common bile duct stones (CBDS) can vary significantly in the UK. We aimed to assess this variability in practice and challenges to form a basis for future consensus. METHODS An electronic survey containing 40 questions on various aspects of management of CBDS was sent to surgeons who perform cholecystectomies via five surgical associations. RESULTS A total of 132 surgeons responded to the survey. The speciality of surgeons includes upper gastro-intestinal (68%), general (18%), colorectal (12%), and others (2%). For patients with suspected CBD stones, 80% would choose magnetic resonance cholangio-pancreatography, and 14.4% would proceed to intra-operative imaging. Most surgeons preferred intra-operative cholangiogram over intra-operative ultrasound (83% vs 17%). For the treatment, 62.1% preferred a two-stage approach [endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)] and 33.4% chose a single-stage approach [LC + laparoscopic common bile duct exploration (LCBDE)]. Eighty (60.6%) responders performed LCBDE, and 19 (23.8%) of them performed > 10 LCBDEs in a year. Two third of surgeons (62.5%) preferred a trans-choledochal approach to CBDS. Half of the surgeons that perform LCBDE use a T-tube selectively and 1.6% routinely. The "availability of very good ERCP service" and "lack of formal training" were the two main reasons for surgeons not performing LCBDE. Both surgeons' speciality and whether they perform other complex laparoscopic surgery were significantly associated with choosing a two-stage approach over a one-stage approach (χ2 test, speciality p = 0.033, complex surgery p = 0.011). CONCLUSION Our survey confirms the significant variability in the diagnosis and management of CBDS. The two-stage approach is still the most common way of managing CBDS in the UK. The main reasons for the low uptake of the single-stage approach are the availability of good ERCP service, lack of equipment and lack of formal training in the technique of LCBDE.
Collapse
Affiliation(s)
- Andrei Tanase
- Peninsula HPB Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Ashwin Dhanda
- South West Liver Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Matthew Cramp
- South West Liver Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
- Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Adam Streeter
- Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK
| | - Somaiah Aroori
- Peninsula HPB Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.
- Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK.
| |
Collapse
|
174
|
Bagepally BS, Sajith Kumar S, Natarajan M, Sasidharan A. Incremental net benefit of cholecystectomy compared with alternative treatments in people with gallstones or cholecystitis: a systematic review and meta-analysis of cost–utility studies. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000779. [PMID: 35064024 PMCID: PMC8785172 DOI: 10.1136/bmjgast-2021-000779] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022] Open
Abstract
IntroductionCholecystectomy is a standard treatment in the management of symptomatic gallstone disease. Current literature has contradicting views on the cost-effectiveness of different cholecystectomy treatments. We have conducted a systematic reappraisal of literature concerning the cost-effectiveness of cholecystectomy in management of gallstone disease.MethodsWe systematically searched for economic evaluation studies from PubMed, Embase and Scopus for eligible studies from inception up to July 2020. We pooled the incremental net benefit (INB) with a 95% CI using a random-effects model. We assessed the heterogeneity using the Cochrane-Q test, I2 statistic. We have used the modified economic evaluation bias (ECOBIAS) checklist for quality assessment of the selected studies. We assessed the possibility of publication bias using a funnel plot and Egger’s test.ResultsWe have selected 28 studies for systematic review from a search that retrieved 8710 studies. Among them, seven studies were eligible for meta-analysis, all from high-income countries (HIC). Studies mainly reported comparisons between surgical treatments, but non-surgical gallstone disease management studies were limited. The early laparoscopic cholecystectomy (ELC) was significantly more cost-effective compared with the delayed laparoscopic cholecystectomy (DLC) with an INB of US$1221 (US$187 to US$2255) but with high heterogeneity (I2=73.32%). The subgroup and sensitivity analysis also supported that ELC is the most cost-effective option for managing gallstone disease or cholecystitis.ConclusionELC is more cost-effective than DLC in the treatment of gallstone disease or cholecystitis in HICs. There was insufficient literature on comparison with other treatment options, such as conservative management and limited evidence from other economies.PROSPERO registration numberCRD42020194052.
Collapse
Affiliation(s)
| | - S Sajith Kumar
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - Meenakumari Natarajan
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| | - Akhil Sasidharan
- Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India
| |
Collapse
|
175
|
Han SJ, Chang JH, Gweon TG, Kim TH, Kim HK, Kim CW. Analysis of symptomatic recurrences of common bile ducts stones after endoscopic removal: Factors related to early or multiple recurrences. Medicine (Baltimore) 2022; 101:e28671. [PMID: 35060565 PMCID: PMC8772677 DOI: 10.1097/md.0000000000028671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
Early or multiple recurrences of symptomatic common bile duct (CBD) stones are troublesome late complications after endoscopic stone removal. We aimed to determine the factors related to early or multiple recurrences of CBD stones.We retrospectively analyzed patients who underwent endoscopic CBD stone extraction in a single institute between January 2006 and December 2015. Patients were divided into 2 groups according to the number and interval of CBD stone recurrences: single versus multiple (≥2) and early (<1.5 years) versus late (≥1.5 years) recurrence.After exclusion, 78 patients were enrolled and followed up for a median of 1974 (IQR: 938-3239) days. Twenty-seven (34.6%) patients experienced multiple recurrences (≥2 times), and 26 (33.3%) patients experienced early first recurrence (<1.5 years). In the multivariate analysis, CBD angulation was independently related to multiple CBD stone recurrence (OR: 4.689, P = .016), and endoscopic papillary large balloon dilation was independently related to late first CBD stone recurrence (OR: 3.783, P = .025). The mean CBD angles were more angulated with increasing instances of recurrence (0, 1, 2, 3, and ≥4 times) with corresponding values of 150.3°, 148.2°, 143.6°, 142.2°, and 126.7°, respectively (P = .011). The period between the initial treatment and first recurrence was significantly longer than the period between the first and second recurrence (P = .048).In conclusion, greater CBD angulation is associated with the increased number of CBD stone recurrence, and EPLBD delays the recurrence of CBD stones after endoscopic CBD stone removal.
Collapse
|
176
|
Tartaglia D, Coccolini F, Cremonini C, Strambi S, Musetti S, Cicuttin E, Di Dato A, Cobuccio L, Cengeli I, Pucciarelli M, Chiarugi M. Laparoscopic cholecystectomy for acute calculous cholecystitis in elderly. More complex but equally safe and effective. Ann Ital Chir 2022; 93:550-556. [PMID: 36254774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM Acute calculous cholecystitis (ACC) is one of the most common pathologies in the elderly. Laparoscopy is the gold standard for ACC treatment, regardless of age. This study aimed to compare different classes of elderly patients affected by ACC and assess whether laparoscopy has the same safety and effectiveness as younger patients. MATERIALS AND METHODS Patients aging ≠ 70 y-o presenting with ACC treated with laparoscopic cholecystectomy were prospectively enrolled from 2010 to 2020. Three groups were identified: age 70-75 (Group 1); age 76-80 (Group 2); Age > 80 (Group 3). Major postoperative complications were considered as more than grade II according to the Clavien and Dindo classification. Demographic, intra-, and postoperative outcomes were compared. A multivariate analysis was also performed to identify predictive factors of morbidity. RESULTS We reviewed 832 patients: 302 (36.3%) were ≠ 70 y-o. Group 1 accounted for 124 patients (41.1%), group 2 for 74 (24.5%) and group 3 for 104 (34.3%). Male gender was significantly less represented with increasing ages (p<0.001). ASA score >2 (p=0.010), CACI score (p<0.001), and ERD score (p<0.001) were more frequent in group 3. No significant differences were found about AAST distribution and comorbidities. Conversion to open rate was significantly higher in group 1 (6.5%) and group 3 (8.7%) (p=0.019). Common bile duct stones rate was higher in group 3 (14.5% vs 13.5% vs 31.7%; p<0.001). Median postoperative hospital length of stay was increasingly longer (p<0.001). AAST grade ≠ 3 (OR 3.187; 95% CI 1.356-7.489; p=0.008), age ≠ 70 y-o (OR 3.358; p<0.001), and CBD stones (OR 2.912; 95% CI 1.456-5.824; p=0.003) were identified as predictive factors of morbidity between < and ≠ 70 ys. Among the three groups of elderly, age > 80 ys was associated with an increase of OR of postoperative complication by 2.94 (95% CI 1.099-7.912; p = 0.032). CONCLUSIONS Laparoscopy can be safely offered in elderly patients, although longer postoperative hospital stay. The presence of associated CBD stones may increase the risk of morbidity. KEY WORDS Acute calculous cholecystitis, Cholecystectomy, Common bile duct lithiasis, Elderly, Frailty, Laparoscopy.
Collapse
|
177
|
Vasilescu AM, Tarcoveanu E, Bradea C, Lupascu C, Stagnitti F. Gallstone Ileus. What therapeutic options are there? Ann Ital Chir 2022; 92:300-306. [PMID: 35122424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gallstone ileus is a rare disorder in emergency surgical practice with diagnosis usually difficult and only achieved at surgery. The current approaches are: enterolithotomy, cholecystectomy and fistula repair (one-stage surgery), enterolithotomy with cholecystectomy performed later (two-stage surgery) and only enterolithotomy (most reported surgical procedure). METHODS The clinical, operative and follow-up data on 14 consecutive patients treated in our clinic for gallstone ileus was retrospectively reviewed. RESULTS Gallstone ileus was recorded in 0.06% of all operations for biliary lithiasis and 1% of all enteric occlusions. There were 11 women and one men, with a mean age of 77.3 (range 67-100) years. There was a mean delay of 3.16 days for onset of symptoms to admission. Urgent laparotomy confirmed gallstone obstruction and a cholecysto-duodenal fistula (13 cases) or cholecysto-colonic fistula (1 case). We performed one stage surgery in 4 cases, enterolithotomy alone in 8 cases (one case operated initially in another surgical service), Hartman procedure, cholecystectomy and fistula repair in one case and a spontaneous evacuation of the gallstone with cholecystectomy and fistula repair later in another case. We recorded 2 deaths in patients with multiple comorbidities in which only enterolithotomy was performed and with 1 and 2 reinterventions, respectively. Postoperative stay was 9.4 days for cases with simple enterolithotomy and 18.6 days for cases with radical treatment. We did not record any recurrence. CONCLUSIONS Although rarely encountered in surgical practice, gallstones ileus should be noted in the differential diagnosis of intestinal obstruction in patients with a past history of biliary disease, occlusive syndrome, pneumobilia and possibly ectopic gallstone. The one-stage procedure should be the offered to stabilized patients, but in cases with associated comorbidities, only enterolithotomy represent a best option. KEY WORDS Gallstone ileus, Cholecystoduodenal fistula, Intestinal Obstruction.
Collapse
|
178
|
Akmal AM, Putra BP, Darmaningrat CIAA, Nariswari IGARC, Srigede LD, Budyono C. Management of Cholelithiasis with Concomitant Choledocholithiasis. Acta Med Indones 2022; 54:151-157. [PMID: 35398838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cholelithiasis refers to a condition in which hardened deposits exist within the gall bladder. These deposits are also known as gallstones. Among other gastrointestinal diseases, Cholelithiasis is associated with the highest hospital admissions. Those with cholelithiasis are generally asymptomatic. However, symptoms may start to appear in the case of inflammation or the blockage of the bile duct, which occurs in 10-25% of patients with cholelithiasis. The condition in which gallstones are present in the common bile duct is known as choledocholithiasis. Surgery is a curative therapy for cholelithiasis concomitant with choledocholithiasis. Other available options include laparoscopy, endoscopy, percutaneous technique, and open surgery. These methods can be done gradually or in combination. Considering this, there have been controversies about the best management option for the case. Therefore, this article aims to analyze and compare each methods of management.
Collapse
|
179
|
Alnagar A, Elkomy H, Foula M, Sakr M, Nabil W. Laparoscopic management of cholecysto-duodenal fistula after spontaneous resolution of intestinal obstruction component of gallstone Ileus case report and literature review. Rozhl Chir 2022; 101:42-45. [PMID: 35148616 DOI: 10.33699/pis.2022.101.1.42-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gallstone ileus is a rare complication of gallstones and is a comparatively unique cause of intestinal obstruction. It involves the development of a cholecysto-enteric fistula through which a gallstone can pass into the gastrointestinal tract. Spontaneous resolution of intestinal obstruction in gallstone ileus is extremely rare. We report a 71-year-old patient who presented with right hypochondrial pain for four months. She had a three-day history of absolute constipation and abdominal distention two months before presentation that resolved spontaneously. Computed tomography revealed pneumobilia. Laparoscopic exploration showed a cholecysto-duodenal fistula that was divided, the opening in the first part duodenum was closed and cholecystectomy was completed successfully. The presence of pneumobilia in a patient with gallstones should raise the suspicion of bilio-enteric fistula. The obstruction component of gallstone ileus can resolve spontaneously in rare occasions. Single stage laparoscopic management of cholecysto-duodenal fistula is safe and feasible in the presence of an experienced laparoscopic surgeon.
Collapse
|
180
|
Shevchenko EG, Al-Kanani JS, Yarosh AL, Soloshenko AV, Karpachev AA, Olejnik NV, Bratishcheva NN, Khalchenko AA. [Endoscopically non-removable stones of the common bile duct]. Khirurgiia (Mosk) 2022:56-60. [PMID: 36469469 DOI: 10.17116/hirurgia202212156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of long-term biliary stenting in the treatment of endoscopically intractable common bile duct stones. MATERIAL AND METHODS The study enrolled 247 patients with endoscopically non-removable bile duct calculi («difficult» choledocholithiasis) divided into two comparable groups. The main group included 129 patients who underwent biliary stenting with original stents with a nanocarbon inert coating (RF patent No. 84226), including those with inclusion of silver nanoclusters (RF patent No. 129397). The control group included 118 patients who underwent all methods of surgical treatment of choledocholithiasis, while biliary stents with original nanocarbon silver-containing inert coating were excluded. The vast majority of patients were women of advanced age (mean 66.8±4.7 and 66.3±5.6, max 89 and 90, min 32 and 37 years, respectively). RESULTS In the control group, all patients underwent endoscopic transpapillary interventions as soon as possible. We could not extract common bile duct stones via endoscopic approach in 56.8% of cases. These patients underwent open or laparoscopic choledocholithotomy with lithoextraction. Complications occurred in 28.5% of cases. Mortality rate was 4.2%. Standard stenting of common bile duct was performed in 28.8% of cases. At the same time, stent dysfunction followed by relapse of obstructive jaundice occurred in 27.1% of patients within 3-3.5 months. Of these, 16 patients (13.5%) underwent stent removal and lithoextraction. Re-stenting was performed in 18 patients (15.3%). Moreover, shock wave lithotripsy with subsequent removal of common bile duct calculi was performed in 8 (6.8%) of these patients the next day. In the main group, original biliary plastic stents with nanocarbon silver-containing inert coating were implanted in all patients. Under permanent therapy with ursodeoxycholic acid drugs, we observed significant shrinkage of calculi to 11.8±1.8 mm and decrease in their density. This made it possible to carry out successful extraction of calculi in 81 patients (62.8%) after 6±0.3 months. Shock wave lithotripsy was performed in 36 (27.9%) cases. This procedure was successful and allowed final lithoextraction in 28 patients (21.7%). Re-stenting was performed in 15 (11.6%) cases, laparotomy - in 5 (3.9%) patients. Mortality rate was 0.78%. CONCLUSION Our data allow us to discuss high efficiency of long-term bile duct stenting with plastic stents with nanocarbon silver-containing inert coating in complex treatment of choledocholithiasis. This approach ensures acceptable incidence of undesirable complications and mortality. This situation undoubtedly dictates the need for further larger prospective studies.
Collapse
Affiliation(s)
| | | | - A L Yarosh
- Belgorod National Research University, Belgorod, Russia
| | | | - A A Karpachev
- Belgorod National Research University, Belgorod, Russia
| | - N V Olejnik
- Belgorod National Research University, Belgorod, Russia
| | | | | |
Collapse
|
181
|
Binh NT, Ly NTL, Hien PN, Linh LT, Lenh BV, Duc NM. Percutaneous Transhepatic Cholecystolithotomy by Holmium Laser for Non"&#".ord($0).";""&#".ord($0).";""&#".ord($0).";"high-Risk Patients with Symptomatic Gallbladder Stones. Med Arch 2022; 76:29-33. [PMID: 35422566 PMCID: PMC8976887 DOI: 10.5455/medarh.2022.76.29-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/04/2022] Open
Abstract
Background: The development of gallstones, also known as cholelithiasis, is one of the most common diseases associated with the gastrointestinal tract. In developing countries 10% to 15% of men and >25% of women experience gallstones. Objective: The aim of the study was to evaluate the outcomes following percutaneous transhepatic cholecystolithotomy by holmium laser in non–high-risk patients with symptomatic gallbladder stones. Methods: This was an intervention study without control and with longitudinal follow-up. Subjects included patients who had only gallbladder stones, a normal gallbladder contractility index, and required a conservative treatment. Results: The study included 44 patients (20 men, 24 women), with a mean age of 41.5 ± 13.4 years. The success rate was 97.7%, and only 1 of 44 patients required follow-up laparoscopic cholecystectomy. Gallstones were successfully removed from 43 of 44 patients (97.7%). The complication rate was 13.6% (6/44 patients), and only minor complications were reported for 5 of the 6 patients with complications. In 34 of 43 patients, follow-up examinations were performed after 1 and 6 months. The gallstone recurrence rate at six-month follow-up was 11.8%, and a collapsed gallbladder was detected in 1 of 34 patients, with the remaining 33 patients retaining normal gallbladder contractility indices (>40%). Conclusion: Percutaneous transhepatic cholecystolithotomy by holmium laser has a high gallstone removal rate (97.7%); however, recurrence remains a major problem. The complication rate was about 13.6%, most of which were minor complications. Cases associated with treatment failure or serious complications should be detected and treated promptly.
Collapse
Affiliation(s)
- Nguyen Thai Binh
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ngo-Thi Ly Ly
- Radiology Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Phan Nhan Hien
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Le Tuan Linh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bui-Van Lenh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Hanoi, Vietnam
| |
Collapse
|
182
|
Wang DQH, Portincasa P, Liu M, Tso P. Overcoming Ductal Block: Emergency ERCP and Sphincterotomy Plus Common Bile Duct Stenting Improves Therapeutic Outcomes in Severe Gallstone Pancreatitis. Dig Dis Sci 2022; 67:11-13. [PMID: 33742290 PMCID: PMC8450299 DOI: 10.1007/s10620-021-06905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/09/2022]
Affiliation(s)
- David Q-H Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| | - Patrick Tso
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45237, USA
| |
Collapse
|
183
|
Lyu J, Lin Q, Fang Z, Xu Z, Liu Z. Complex impacts of gallstone disease on metabolic syndrome and nonalcoholic fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:1032557. [PMID: 36506064 PMCID: PMC9727379 DOI: 10.3389/fendo.2022.1032557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with gallstone disease (GSD) often have highly co-occurrence with metabolic syndrome (MetS) and Nonalcoholic fatty liver disease (NAFLD) both associated with insulin resistance (IR). Meanwhile, highly prevalence of NAFLD was found in patients who received cholecystectomy. However, the associations of GSD with MetS, NAFLD is inconsistent in the published literature. And risk of cholecystectomy on NAFLD is unclear. METHODS We searched the Medline EMBASE and WOS databases for literature that met our study topic. To be specific, studies with focus on associations between GSD and MetS/NAFLD, and risk evaluation on cholecystectomy and NAFLD incidence were enrolled for further analysis. The random effect model was used to calculate the combined relative ratio (RR) and odds ratio (OR)and 95% confidence interval (CI). RESULTS Seven and six papers with focus on connections between GSD and NAFLD/MetS prevalence. Correspondingly, seven papers with focus on risk of cholecystectomy on NAFLD occurrence were also enrolled into meta-analysis. After pooling the results from individual study, patients with GSD had higher risk of MetS (OR:1.45, 95%CI: 1.23-1.67, I2 = 41.1%, P=0.165). Risk of GSD was increased by 52% in NAFLD patients (pooled OR:1.52, 95%CI:1.24-1.80). And about 32% of increment on NAFLD prevalence was observed in patients with GSD (pooled OR: 1.32, 95%CI:1.14-1.50). With regard to individual MetS components, patients with higher systolic blood pressure were more prone to develop GSD, with combined SMD of 0.29 (96%CI: 0.24-0.34, P<0.05). Dose-response analysis found the GSD incidence was significantly associated with increased body mass index (BMI) (pooled OR: 1.02, 95%CI:1.01-1.03) in linear trends. Patients who received cholecystectomy had a higher risk of post-operative NAFLD (OR:2.14, 95%CI: 1.43-2.85), P<0.05). And this impact was amplified in obese patients (OR: 2.51, 95%CI: 1.95-3.06, P<0.05). CONCLUSION Our results confirmed that controls on weight and blood pressure might be candidate therapeutic strategy for GSD prevention. And concerns should be raised on de-novo NAFLD after cholecystectomy.
Collapse
Affiliation(s)
- Jingting Lyu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Qinghong Lin
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhongbiao Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zeling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Zhengtao Liu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
- NHC Key Laboratory of Combined Multi-Organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Key Laboratory of Organ Transplantation, Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Shulan (Hangzhou) Hospital, Hangzhou, China
- *Correspondence: Zhengtao Liu, ;
| |
Collapse
|
184
|
Wang J, Yang J, Chen Y, Rui J, Xu M, Chen M. Association of METS-IR index with prevalence of gallbladder stones and the age at the first gallbladder stone surgery in US adults: A cross-sectional study. Front Endocrinol (Lausanne) 2022; 13:1025854. [PMID: 36263324 PMCID: PMC9574223 DOI: 10.3389/fendo.2022.1025854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the correlation between the metabolic score for insulin resistance (METS-IR) index and gallbladder stoneprevalence in US adults, as well as the age at first gallbladder stone surgery. METHODS A logistic regression analysis, subgroup analysis, and dose-response curve were computed for participants in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between the METS-IR index and gallbladder stone prevalence and age at first surgery for gallbladder stones. RESULTS This study ultimately included 9452 participants aged >20 years, of whom 534 self-reported a history of gallbladder stones, and after adjusting for all confounders, each unit increase in METS-IR index was associated with a 3.3% increase in gallbladder stone prevalence (OR= 1.033, 95% CI: 1.0258, 1.0403) along with an earlier age at first gallbladder stone surgery 0.26 years (β= -0.26, 95% CI: -0.35, -0.17), stratified analysis showed that increased METS-IR index was associated with increased prevalence of gallbladder stones in all subgroups, and the dose-response curve showed a positive linear correlation between METS-IR index and prevalence of gallbladder stones, while a negative linear correlation was observed between increased METS-IR index and age at first gallbladder stone There was a negative linear correlation between age at surgery. CONCLUSION The METS-IR index has been positively associated with gallbladder stone prevalence, thereby contributing to age at first surgery for gallbladder stones. However, the causal relationship between the METS-IR and gallbladder stones cannot be concluded.
Collapse
Affiliation(s)
- Jin Wang
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Junping Yang
- Department of General Practice, Wuhu City Second People‘s Hospital, Wuhu City, China
| | - Yan Chen
- Department of General Practice, Wuhu City Second People‘s Hospital, Wuhu City, China
| | - Jing Rui
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Maoqi Xu
- Department of General Surgery, The Traditional Chinese Medicine Hospital of Wuhu, Wuhu City, China
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei City, China
- *Correspondence: Mingwei Chen,
| |
Collapse
|
185
|
Miller H, Schulte W, Mogl M. Gallstone Ileus Without Pneumobilia. Dtsch Arztebl Int 2021; 118:892. [PMID: 35321788 PMCID: PMC8962505 DOI: 10.3238/arztebl.m2021.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
|
186
|
DUMAN AE, YILMAZ H, HÜLAGÜ S. Biliary stents are forgotten more frequently in elderly patients. Turk J Med Sci 2021; 51:3067-3072. [PMID: 34579509 PMCID: PMC10734834 DOI: 10.3906/sag-2104-108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 12/13/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background/aim Plastic biliary stents that remain in situ for more than 12 months, called forgotten biliary stents (FBSs), can cause complications such as cholangitis, stent migration, stent occlusion, and perforation. Materials and methods The medical records of patients who underwent ERCP procedures from December 2016 to December 2020 were analysed retrospectively. Data on patient characteristics, indications for ERCP and stenting, stent types, stenting duration, complications, and causes of FBSs were obtained from the hospital’s database. Results A total of 48 cases with FBSs were analysed. The mean age (SD) of the patients was 71.23 years (±12.165), the male-to-female ratio was 23/25 (0.92), and the mean stenting duration was 27.12 months (range: 12–84 months). The most common indication for biliary stenting was irretrievable choledochal stones (40/48). Stone formation (79%) and proximal stent migration (26.4%) were the most frequent complications. The patients in the FBS group were significantly older than those from whom stents were removed in a timely manner (71.23 vs. 62.43 years, p < 0.001). Endoscopic treatment was possible in all cases; surgery was not required in any case. The most common cause of FBSs cited by patients was not having been informed about the need for long-term management of their stents (n = 14, 29.2%) Conclusion FBSs are potentially problematic particularly in elderly patients. Communication with the patient to remind them of the need for stent management is important for preventing FBSs.
Collapse
Affiliation(s)
- Ali Erkan DUMAN
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkey
| | - Hasan YILMAZ
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkey
| | - Sadettin HÜLAGÜ
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Kocaeli,
Turkey
| |
Collapse
|
187
|
Dong CC, Jiang XJ, Shi XY, Li B, Chen L. Risk factors for bile duct injury after laparoscopic cholecystectomy: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28191. [PMID: 34889299 PMCID: PMC8663869 DOI: 10.1097/md.0000000000028191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Bile duct injury (BDI) is one of the serious complications in laparoscopic cholecystectomy (LC), but there is currently a lack of systematic review of risk factors related to BDI after LC. This study conducts meta-analysis on the risk factors related to bile duct injury after LC, the purpose is to provide reference basis for preventing and reducing BDI after LC. METHODS Using the Computer to retrieve of Chinese and English databases such as CNKI, WANFANG Data, the VIP Network, PubMed, Embase, the Cochrane Library, etc. The time is from the establishment of each database until August 2021. A case-control study is selected that is related to the risk factors of BDI after LC. This meta-analysis using RevMan 5.4 and State 12.0 software is performed after two researchers independently sift through the literature, extract the data, and evaluate the bias risk included in the study. RESULTS The risk factors related to BDI after LC will be analyzed by systematic review. CONCLUSION The conclusion of this study will play an important role in reducing BDI after LC. OSF REGISTRATION DOI 10.17605/OSF.IO/2B3K9, the registration URL is https://osf.io/2b3k9.
Collapse
Affiliation(s)
- Chang-Cheng Dong
- Department of General Surgery, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region, China
| | - Xue-Jun Jiang
- Department of General Surgery, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region, China
| | - Xue-Ying Shi
- Department of General Surgery, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region, China
| | - Bing Li
- Department of General Surgery, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region, China
| | - Liang Chen
- Department of Hematology, Inner Mongolia Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region, China
| |
Collapse
|
188
|
Hurst KV, Peiris GB, Booth M. Conservative management of the colonic gallstone. BMJ Case Rep 2021; 14:e243040. [PMID: 34848404 PMCID: PMC8634209 DOI: 10.1136/bcr-2021-243040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2021] [Indexed: 11/04/2022] Open
Abstract
A 74-year-old woman presents with a 7-day history of increasing lower abdominal pains and reduced bowel movements; resulting in absolute constipation.Twenty-four hours prior to admission she also had symptoms of nauseous and significant abdominal distention. Her past medical history included; diverticulitis, type 2 diabetes, hypercholesterolemia, an ultrasound scan in 2005 confirming gallstones, but no previous abdominal surgery.She was initially treated for bowel obstruction and a CT arranged. CT showed a 4.5 cm gallstone in mid-sigmoid colon and a cholecystocolonic fistula. She was booked for colonoscopy±laparotomy, but on the morning of her planned procedure she repeatedly opened her bowels. Subsequent colonoscopy was negative and repeat CT confirmed the stone was no longer within the gastrointestinal tract.
Collapse
Affiliation(s)
| | | | - Michael Booth
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| |
Collapse
|
189
|
Tringali A, Costa D, Fugazza A, Colombo M, Khalaf K, Repici A, Anderloni A. Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review. World J Gastroenterol 2021; 27:7597-7611. [PMID: 34908801 PMCID: PMC8641054 DOI: 10.3748/wjg.v27.i44.7597] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/23/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic management for difficult common bile duct (CBD) stones still presents a challenge for several reasons, including anatomic anomalies, patients’ individual conditions and stone features. In recent years, variable methods have emerged that have attributed to higher stone removal success rates, reduced cost and lower adverse events. In this review, we outline a stepwise approach in CBD stone management. As first line therapy, endoscopic sphincterotomy and large balloon dilation are recommended, due to a 30%-50% reduction of the use of mechanical lithotripsy. On the other hand, cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence. As discussed, findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions. Furthermore, we evaluate the management of CBD stones in various surgical altered anatomy (Billroth II, Roux-en-Y and Roux-en-Y gastric bypass). Moreover, we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use, rather than following a failed management option. In addition, we discuss the importance of dissecting other techniques, such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed. In conclusion, we recognize that endoscopic sphincterotomy and large balloon dilation, mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones, but emerging techniques are in rapid evolution with encouraging results.
Collapse
Affiliation(s)
- Alberto Tringali
- Gastroenterology and Endoscopy Unit, Department of Medicine, Conegliano Hospital, ULSS 2 Marca Trevigiana, Conegliano 31015, Italy
| | - Deborah Costa
- Gastroenterology and Endoscopy Unit, Department of Medicine, Conegliano Hospital, ULSS 2 Marca Trevigiana, Conegliano 31015, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Matteo Colombo
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| |
Collapse
|
190
|
Mahoney RC, Marison SR, Marumoto AD, Hemmings DE. Enormous Gallstone Discovered in the Setting of Acute-on-chronic Cholecystitis. Hawaii J Health Soc Welf 2021; 80:38-40. [PMID: 34820634 PMCID: PMC8609192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Biliary disease is a common surgical problem. A unique case of a 53-year-old male with an enormous gallstone precluding safe laparoscopic cholecystectomy is presented. The patient was a 53-year-old male who presented to the emergency department with a 1-day history of abdominal pain for which clinical findings were consistent with acute cholecystitis. A laparoscopic cholecystectomy was attempted, but could not be safely completed due to an enormous gallstone prohibiting attainment of the critical view of safety. The stone measured 12.2 cm × 5.2 cm × 5.2 cm. Although biliary disease is very common and its management well documented, it is rare to uncover stones larger than 5 centimeters in diameter. Clinicians should be aware that enormous gallstones require prompt surgical intervention if discovered in the elective setting to minimize future morbidity should cholecystitis develop; early elective cholecystectomy should be considered upon discovery of large gallstones to prevent encountering a gallbladder with decreased mobilization in the setting of inflamed tissues.
Collapse
Affiliation(s)
- Reid C. Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Scott R. Marison
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Ashley D. Marumoto
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Daphne E. Hemmings
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| |
Collapse
|
191
|
D'Amata G, Del Papa M, Palmieri I, Manzi F, Musmeci L, Florio G, Buonocore V, Demoro M, Antonellis F. Cholecystogastric fistula. A case report and literature review. Ann Ital Chir 2021; 10:S2239253X21036483. [PMID: 34982734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cholecystogastric fistulas is a rare complication of gallstone. Even if well described in the literature, this condition still poses a debate on diagnosis and surgical treatment. We present a case of a 35 year's old female which unexpectedly presented a cholecystogastric fistula during a laparoscopic cholecystectomy, treated successfully with fistula transection and repair and cholecystectomy through an open access. The open access remains the preferable option in this cases but laparoscopic techniques are being used worldwide with increasing success. The preoperative diagnosis remains difficult for the unspecific symptoms. KEY WORDS: Biliodigestive Fistula, Gallstone Ileus, Gastric Fistula, Biliary Fistula, Cholecystitis.
Collapse
|
192
|
Revathi G, Singh BK, Rathore YS, Chumber S. Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature. BMJ Case Rep 2021; 14:e244393. [PMID: 34645627 PMCID: PMC8515435 DOI: 10.1136/bcr-2021-244393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/03/2022] Open
Abstract
A young adult male presented with biliary colic and intermittent jaundice for 1 year. Abdomen findings were unremarkable. Routine investigations revealed a raised total bilirubin. On abdominal ultrasonography, common bile duct (CBD) dilatation with multiple stones was noted. On further imaging with magnetic resonance cholangiopancreatography, type I choledochal cyst (CDC) was suspected. A laparoscopic approach was planned. Intraoperatively, dilatation of cystic duct was noted which constitute type VI CDC. Partial malrotation of the gut and accessory right hepatic artery were also noted as incidental finding. Laparoscopic cholecystectomy with CBD exploration and removal of stones, biliary stent placement, cystic duct cyst excision and primary repair of CBD was done. Postoperatively, the patient improved symptomatically with a fall in bilirubin to normal range. We are describing the laparoscopic management of a rare case of type IV CDC which was diagnosed intraoperatively.
Collapse
Affiliation(s)
- G Revathi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Brijesh Kumar Singh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Yashwant Singh Rathore
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
193
|
Cusmai L, Siboni S, Bonavina L. Impacted Gallstone in the Duodenum: What to Do? J Clin Gastroenterol 2021; 55:821. [PMID: 34091517 DOI: 10.1097/mcg.0000000000001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Lorenzo Cusmai
- IRCCS Policlinico San Donato Division of General and Foregut Surgery, University of Milan, Milan, Italy
| | | | | |
Collapse
|
194
|
Abstract
Crohn's disease (CD) is a chronic inflammatory condition, which typically involves the small and large bowel but can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, diarrhoea, fatigue, weight loss and malnutrition. Complications of CD include gallstone formation and cholecystitis. Impaired reabsorption of bile salts in the small bowel and CD-related surgeries are key factors in the development of CD-related gallstones, although other factors are also important. Direct CD-related inflammation of the gallbladder is very unusual and the typical histological features of CD are rarely encountered in cholecystectomy specimens of individuals with CD. We present a case of a man in his early 60s with CD, previous right hemicolectomy and a history of gallstones, who presented with chronic cholecystitis. Following cholecystectomy, pathological examination of the gallbladder unexpectedly demonstrated typical features of CD, including lymphoid aggregates and non-caseating mucosal granulomata.
Collapse
Affiliation(s)
- Callam Scott
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Amit Patel
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Noori Maka
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan C MacDonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
- Department of Medicine, University of Glasgow School of Medicine Dentistry and Nursing, Glasgow, UK
| |
Collapse
|
195
|
Yin Y, He K, Xia X. Comparison of Primary Suture and T-Tube Drainage After Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy in the Treatment of Secondary Common Bile Duct Stones: A Single-Center Retrospective Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:612-619. [PMID: 34520269 DOI: 10.1089/lap.2021.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare the safety and feasibility of T-tube drainage and primary suture after laparoscopy combined with choledochoscopy in the treatment of secondary choledocholithiasis. Methods: The clinical data of patients who underwent laparoscopic choledochoscopy combined with choledochoscopic common bile duct exploration (LCBDE) for secondary choledocholithiasis from June 2015 to June 2020 were analyzed retrospectively. According to the different treatment method of common bile duct (CBD) incision, the patients were divided into a T-tube drainage group and a primary suture group. The preoperative clinical characteristics, results of preoperative liver function tests (LFTs), LFTs on the first day after the operation and the fourth day after the operation, operation time, intraoperative bleeding, postoperative complications, and times of postoperative hospital stay were compared between the two groups. Results: There was no significant difference in preoperative clinical data, preoperative LFTs, and postoperative complications between the two groups (P > .05). However, primary suture demonstrated significant advantages (P < .05) in terms of the operation time, intraoperative blood loss, postoperative hospital stay, and other related factors. Bilirubin levels on the first day after the operation and the fourth day after the operation between the two groups suggested that T-tube drainage reduces bilirubin in the short term, but that long-term bilirubin draining is similar between the two strategies. Univariate and multivariate analyses showed that choledochal diameter less than 8 mm was an independent risk factor for bile leakage. Conclusions: Laparoscopy combined with intraoperative choledochoscopic CBD exploration is superior to T-tube drainage in terms of the operation time, intraoperative blood loss, and postoperative hospital stay. The ability of reducing bilirubin by traditional T-tube drainage is indeed better than that of primary suture in the early stage after operation, but there is no difference in long-term outcome between the two groups. Choledochal diameter ≤8 mm was an independent risk factor for bile leakage. To summarize, LCBDEs primary suture for secondary choledocholithiasis is safe and feasible.
Collapse
Affiliation(s)
- Yifeng Yin
- Clinical Medical College, Department of Hepatobiliary Surgery, Southwest Medical University, Luzhou, China
| | - Kai He
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xianming Xia
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| |
Collapse
|
196
|
Affiliation(s)
- Sandra Hapca
- University of Aberdeen School of Medicine and Dentistry, Foresterhill, Aberdeen AB25 2ZD, UK
| | - George Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen
| | - Peter Murchie
- Institute of Applied Health Sciences, Academic General Practice, University of Aberdeen, Aberdeen
| | - Irfan Ahmed
- Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen
| |
Collapse
|
197
|
Kamezaki H, Iwanaga T, Maeda T, Senoo JI, Sakamoto D, Yasui S, Sugiyama H, Tsuyuguchi T, Kato N. Long-term effects of endoscopic papillary large balloon dilation in patients with challenging bile duct calculi: A retrospective observational study. Medicine (Baltimore) 2021; 100:e27227. [PMID: 34516527 PMCID: PMC8428757 DOI: 10.1097/md.0000000000027227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/27/2021] [Indexed: 01/05/2023] Open
Abstract
Endoscopic papillary large balloon dilation (EPLBD) can be used to treat challenging common bile duct stones. No previous studies have reported intractable cases treated either by EPLBD or mechanical lithotripter use. We aimed to evaluate and compare the long-term effects of EPLBD with mechanical lithotripter use.This retrospective cohort study reviewed data from 153 patients admitted to the Eastern Chiba Medical Center from April 2014 to March 2020, presenting with common bile duct calculi that could not be removed using a basket or balloon catheter. Patients were divided into groups depending on whether the treatment was performed using a mechanical lithotripter or EPLBD. The primary outcome was the recurrence rate of common bile duct calculi, and the secondary outcome was the rate of postoperative adverse events. The Wilcoxon test was used to compare the 2 groups. Statistical significance was set at P < .05.The median age of patients included in the lithotripter and EPLBD groups were 73 years and 83 years, respectively (P = .006), while the sex ratio (male:female) in the groups was 18:13 and 55:67, respectively. The EPLBD group showed a statistically larger median bile duct diameter (13 mm [range: 8-24 mm] vs 11 mm [range: 5-16 mm]; P < .001), larger maximal calculus diameter (median, 13.5 mm [range: 8-25 mm] vs 11 mm [range: 7-16 mm]; P < .001), and shorter median cumulative treatment time after reaching the duodenal papilla (35.5 minutes [range: 10-176 minutes] vs 47 minutes [range: 22-321 minutes]; P = .026) in comparison to the lithotripter group. There was no significant difference in the rate of adverse events between the EPLBD and the mechanical lithotripter groups. The recurrence rate was significantly lower (P = .014) in the EPLBD group.EPLBD increases therapeutic efficacy and reduces treatment duration for patients in whom calculus removal is difficult, without increasing the frequency of adverse events. No serious adverse events were observed. Additionally, EPLBD appears to reduce the risk of long-term recurrence. Future studies are needed to evaluate long-term outcomes in younger patients.
Collapse
Affiliation(s)
- Hidehiro Kamezaki
- Department of Gastroenterology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Terunao Iwanaga
- Department of Gastroenterology, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahiro Maeda
- Department of Gastroenterology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Jun-ichi Senoo
- Department of Gastroenterology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Dai Sakamoto
- Department of Gastroenterology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Shin Yasui
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Katori, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
198
|
Popescu RC, Leopa N, Dumitru A, Dan C, Dosa A, Bosneagu R, Iordache IE, Botea F. Residual Gallbladder and Cystic Duct Stump Stone after Cholecystectomy: Laparoscopic Management. Chirurgia (Bucur) 2021; 116:484-491. [PMID: 34498567 DOI: 10.21614/chirurgia.116.4.484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Cholecystectomy is the standard treatment for symptomatic gallstones, and the persistence of symptoms after surgery defines postcholecystectomy syndrome. Biliary causes of postcholecystectomy syndrome include subtotal cholecystectomy and remnant cystic duct stump stone; causes that are encountered with a low frequency, but which require diagnosis and provocative treatment. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. Methods: This study is a retrospective analysis of patients who required surgical treatment for residual gallbladder and cystic duct stump stone after a cholecystectomy, hospitalized in the Surgery Department of Constanta County Hospital, who required completion of resection and were operated laparoscopically. Results: Between January 2010 and March 2020, 14 patients were hospitalized with residual gallbladder and cystic duct stump stone that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by recurrent biliary colic (50%). The period between the primary surgery and the surgery to complete the resection varied between 2-22 years. There were 4 cases of subtotal cholecystectomies, and 10 cases of remnant cystic duct stump stones. Intraoperative complications were encountered in only one case (7.14%), the number of days of hospitalization was on average 3 days. No patient showed any symptoms at 6-month postoperative follow-up. Conclusions: Postcholecystectomy syndrome is difficult to diagnose, symptomatic patients with remnant cystic duct stump stone/ subtotal cholecystectomy requiring surgery are difficult to manage. Laparoscopic surgery is preferred for the benefits that laparoscopic surgery brings, but requires an experienced surgeon in advanced laparoscopic techniques.
Collapse
|
199
|
Wang P, Ma B, Li Z, Xue D. Clinical value of using laparoscopic transcystic common bile duct exploration to diagnose and treat suspected common bile duct stones. Asian J Surg 2021; 44:1608-1610. [PMID: 34511365 DOI: 10.1016/j.asjsur.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pengfei Wang
- Department of Minimally Invasive Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, No.23, You Zheng Street, Harbin, 150001, Heilongjiang, China.
| | - Biao Ma
- Department of Minimally Invasive Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, No.23, You Zheng Street, Harbin, 150001, Heilongjiang, China.
| | - Zhituo Li
- Department of Minimally Invasive Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, No.23, You Zheng Street, Harbin, 150001, Heilongjiang, China.
| | - Dongbo Xue
- Department of Minimally Invasive Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, No.23, You Zheng Street, Harbin, 150001, Heilongjiang, China.
| |
Collapse
|
200
|
Andreozzi P, de Nucci G, Devani M, Redaelli D, Schettino M, Iuliano D, Zulli C, Maurano A, Bottiglieri ME, Paspatis G, Dinelli M, Manes G. The high rate of spontaneous migration of small size common bile duct stones may allow a significant reduction in unnecessary ERCP and related complications: results of a retrospective, multicenter study. Surg Endosc 2021; 36:3542-3548. [PMID: 34494152 DOI: 10.1007/s00464-021-08676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Common bile duct stones (CBDS) can spontaneously migrate through the duodenal papilla. In this case, ERCP could be unnecessary and a significant rate of complications could be avoided. In this study, we aim at retrospectively evaluating the rate of spontaneous stone passage in patients with an imaging diagnosis of CBDS and at analysing the factors associated to spontaneous stone migration. METHODS We conducted a retrospective multi-centre analysis of patients undergoing ERCP for CBDS in a 12-month period. 1016 patients with CBDS were analysed. In all patients CBDS was diagnosed with adequate imaging methods performed prior to ERCP. ERCPs with failed biliary cannulation were excluded. Data regarding patients' characteristics, imaging findings and ERCP procedure were analysed. RESULTS 1016 patients with CBDS undergoing ERCP were analysed (male sex 43.3%; mean age 69.9 ± 16.5 years). Diagnosis of CBDS was obtained by EUS in 415 patients (40.8%), MR in 343 (33.8%), CT in 220 (21.7%), and US in 38 (3.7%). No stones were found at ERCP in 179 patients (17.6%), in 14 (6.2%) when ERCP was performed within 6 h from imaging study, in 114 (18.5%) between 7 h and 7 days, in 32 (24.6%) between 8 and 29 days, and in 19 (43.2%) after 30 days. The rate of unnecessary ERCP occurred significantly more frequently in patients in whom imaging methods demonstrated either sludge or ≤ 5 mm CBDS (29.9 vs. 8.3%; p < 0.001). DISCUSSION Spontaneous migration of small CBDS is a frequent event, and ≤ 5 mm size and a delay in ERCP > 7 days represent predictive factors for it. We suggest that CBDS ≤ 5 mm should not undergo immediate removal and this fact would allow reducing the rate of unnecessary ERCP with their related complications. Prospective studies are needed to confirm these results and demonstrate the safety of a conservative management in this setting.
Collapse
Affiliation(s)
- Paolo Andreozzi
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Germana de Nucci
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Massimo Devani
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Davide Redaelli
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Mario Schettino
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy
| | - Donato Iuliano
- Gastroenterology and Endoscopy Unit, ASL Caserta, Marcianise Hospital, Marcianise, Caserta, Italy
| | - Claudio Zulli
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Attilio Maurano
- Endoscopic Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | | | - Gregorios Paspatis
- Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece
| | - Marco Dinelli
- Gastroenterology and Endoscopy Unit, San Gerardo Hospital, Monza, Italy
| | - Gianpiero Manes
- Department of Gastroenterology, ASST Rhodense, Rho and Garbagnate M.se Hospitals, Viale Forlanini 95, Garbagnate Milanese, Milan, Italy.
| |
Collapse
|