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McDermott J, Kao LS, Keeley JA, Nahmias J, de Virgilio C. Management of Gallstone Pancreatitis: A Review. JAMA Surg 2024:2818236. [PMID: 38691369 DOI: 10.1001/jamasurg.2023.8111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Importance Gallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor. In addition, there is minimal evidence to guide clinicians in the treatment of moderately severe and severe pancreatitis. Observations The management of GSP continues to evolve and is dependent on severity of acute pancreatitis and concomitant biliary diagnoses. Across the spectrum of severity, there is evidence that goal-directed, moderate fluid resuscitation decreases the risk of fluid overload and mortality compared with aggressive resuscitation. Patients with isolated, mild GSP should undergo same-admission cholecystectomy; early cholecystectomy within 48 hours of admission has been supported by several randomized clinical trials. Cholecystectomy should be delayed for patients with severe disease; for severe and moderately severe disease, the optimal timing remains unclear. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is only useful for patients with suspected cholangitis or biliary obstruction, although the concomitance of these conditions in patients with GSP is rare. Modality of evaluation of the common bile duct to rule out concomitant choledocholithiasis varies and should be tailored to level of concern based on objective measures, such as laboratory results and imaging findings. Among these modalities, intraoperative cholangiography is associated with reduced length of stay and decreased use of ERCP. However, the benefit of routine intraoperative cholangiography remains in question. Conclusions and Relevance Treatment of GSP is dependent on disease severity, which can be difficult to assess. A comprehensive review of clinically relevant evidence and recommendations on GSP severity grading, fluid resuscitation, timing of cholecystectomy, need for ERCP, and evaluation and management of persistent choledocholithiasis can help guide clinicians in diagnosis and management.
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Affiliation(s)
- James McDermott
- David Geffen School of Medicine, University of California, Los Angeles
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Jessica A Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange
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Mehendale VG, Kamdar MS, Shenoy SN. Pragmatic algorithm for management of common bile duct calculi in resource-limited settings in India. J Minim Access Surg 2024:01413045-990000000-00044. [PMID: 38557406 DOI: 10.4103/jmas.jmas_293_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) facilitates the removal of common bile duct (CBD) calculi by endoscopy. When ERCP fails, exploration of CBD is required for the clearance of CBD calculi. The optimum way for the exploration of CBD is by choledochoscopy. Dedicated flexible or rigid choledochoscopes are expensive and available only in few places in India. Since 1991, we subjected patients with suspected CBD calculi to ERCP, followed by laparoscopic cholecystectomy (LC). Patients in whom ERCP failed to clear CBD were subjected to open exploration of CBD using any easily available, suitable, straight rigid scope for choledochoscopy. PATIENTS AND METHODS Since March 1991, out of 8866 patients with cholelithiasis, 862 underwent ERCP. Ninety-six patients in whom ERCP failed to clear CBD underwent open exploration of CBD. In each case of exploration of CBD, choledochoscopy was performed using a straight rigid scope, either a cystoscope, paediatric cystoscope, hysteroscope or 5-mm laparoscopy telescope with a 5-mm cannula. RESULTS The CBD clearance was complete in 95 patients, and one patient had an impacted calculus at the ampulla. CBD explorations were followed by choledochoduodenostomy, T-tube placement or suturing of choledochotomy. No residual calculi were observed after such exploration. CONCLUSION From our results, we advocate the following algorithm for CBD calculi in resource-limited settings. Subject patients with CBD calculi to ERCP followed by LC. In case of failed ERCP, open exploration of CBD with choledochoscopy using any suitable rigid scope. Dedicated flexible or rigid choledochoscope is not essential. This approach is cost-effective and successful.
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Affiliation(s)
| | - Manoj S Kamdar
- Medico Surgical Clinic and Hospital, Seth VC Gandhi and MA Vora Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sharad Narayan Shenoy
- Medico Surgical Clinic and Hospital, Seth VC Gandhi and MA Vora Municipal General Hospital, Mumbai, Maharashtra, India
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dos Santos JS, Kemp R, Orquera AGM, Gaspar AF, Júnior JRL, Queiroz LTA, Avezum VAPAF, Ardengh JC, Sankarankutty AK, Lima LS. The Safety and Cost Analysis of Outpatient Laparoendoscopy in the Treatment of Cholecystocholedocholithiasis: A Retrospective Study. J Clin Med 2024; 13:460. [PMID: 38256593 PMCID: PMC10816273 DOI: 10.3390/jcm13020460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations. OBJECTIVE To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis. METHOD A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups-AR (n = 42)-ambulatory regimen and HR (n = 28)-hospitalization regimen-which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. RESULTS The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02). CONCLUSION Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons.
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Affiliation(s)
- José Sebastião dos Santos
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Rafael Kemp
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Alicia Guadalupe Mendoza Orquera
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - Alberto Facury Gaspar
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
| | - Jorge Resende Lopes Júnior
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
| | - Lucas Tobias Almeida Queiroz
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - Víctor Antônio Peres Alves Ferreira Avezum
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
| | - José Celso Ardengh
- University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (J.R.L.J.); (J.C.A.)
- Digestive Endoscopy Service, Hospital Moriah, São Paulo 04084-002, Brazil
- Department of Diagnostic Imaging, Federal University of São Paulo, São Paulo 04021-001, Brazil
| | - Ajith Kumar Sankarankutty
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (R.K.); (A.K.S.)
| | - Leonardo Santos Lima
- Postgraduate Program, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo (FMRP-USP), São Paulo 05508-220, Brazil; (A.G.M.O.); (A.F.G.); (L.T.A.Q.); (V.A.P.A.F.A.); (L.S.L.)
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Wang H, He YQ, Dong SY, Zhong W, Tao P, Yang SY, Liu ZJ. Recurrence of common bile duct stones after choledocholithotomy in elderly patients: risk factor analysis and clinical prediction model development. Front Med (Lausanne) 2023; 10:1239902. [PMID: 37937139 PMCID: PMC10626465 DOI: 10.3389/fmed.2023.1239902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
Background The reasons for the recurrence of common bile duct stones (CBDS) in elderly patients after choledocholithotomy are still unclear. This study aims to establish a prediction model for CBDS recurrence by identifying risk factors. Methods We conducted a retrospective analysis of 1804 elderly patients aged 65 years and above who were diagnosed to have CBDS and were admitted to Nanjing First Hospital between January 1, 2010, and January 1, 2021. According to inclusion and exclusion criteria, 706 patients were selected for the final analysis. The patients were assigned to two groups according to the presence or absence of CBDS recurrence, and their clinical data were then statistically analyzed. Subsequently, a prediction model and nomogram were developed, evaluating effectiveness using the concordance index (C-index). Results Of the 706 elderly patients, 62 patients experienced CBDS recurrence after surgery, resulting in a recurrence rate of 8.8%. The multivariate Cox analysis showed that prior history of cholecystectomy (hazard ratio [HR] = 1.931, 95% confidence interval [CI]: 1.051-3.547, p = 0.034), white blood cell (WBC) count ≥11.0 × 109/L (HR = 2.923, 95% CI: 1.723-4.957, p < 0.001), preoperative total bilirubin (TBIL) level ≥ 36.5 mmol/L (HR = 2.172, 95% CI: 1.296-3.639, p = 0.003), number of stones ≥2 (HR = 2.093, 95% CI: 1.592-5.294, p = 0.001), maximum stone diameter ≥ 0.85 cm (HR = 1.940, 95% CI: 1.090-3.452, p = 0.024), and T-tube drainage (HR = 2.718, 95% CI: 1.230-6.010, p = 0.013) were independent risk factors of CBDS recurrence in elderly patients after choledocholithotomy. A postoperative CBDS recurrence prediction model was constructed with a C-index value of 0.758 (95% CI: 0.698-0.818) and internal validation value of 0.758 (95% CI: 0.641-0.875). Conclusion A history of cholecystectomy, WBC count ≥11.0 × 109/L, preoperative TBIL level ≥ 36.5 mmol/L, number of stones ≥2, maximum stone diameter ≥ 0.85 cm, and T-tube drainage are the independent risk factors of CBDS recurrence after choledocholithotomy in elderly patients. Our developed prediction model for CBDS recurrence has good predictive ability and can help predict the prognosis of patients with CBDS.
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Affiliation(s)
| | | | | | | | | | | | - Zi-jun Liu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Mc Geehan G, Melly C, O' Connor N, Bass G, Mohseni S, Bucholc M, Johnston A, Sugrue M. Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones: a meta-analysis. Eur J Trauma Emerg Surg 2023; 49:2257-2267. [PMID: 36053288 PMCID: PMC10520076 DOI: 10.1007/s00068-022-02070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Symptomatic calculus biliary disease is common with associated morbidity and occasional mortality, further confounded when there is concomitant common bile duct (CBD) stones. Choledocholithiasis and clearance of the duct reduces recurrent cholangitis, but the question is whether after clearance of the CBD if there is a need to perform a cholecystectomy. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post-ERCP clearance offers optimal outcomes over a wait-and-see approach. METHODS A Prospero registered meta-analysis of the literature using PRISMA guidelines incorporating articles related to ERCP, choledocholithiasis, cholangitis and cholecystectomy was undertaken for papers published between 1st January 1991 and 31st May 2021. Existing research that demonstrates outcomes of ERCP with no cholecystectomy versus ERCP and cholecystectomy was reviewed to determine the related key events, complications and mortality of leaving the gallbladder in situ and removing it. Odds ratios (OR) were calculated using Review Manager Version 5.4 and meta-analyses performed using OR using fixed-effect (or random-effect) models, depending on the heterogeneity of studies. RESULTS 13 studies (n = 2598), published between 2002 and 2019, were included in this meta-analysis, 6 retrospective, 2 propensity score-matched retrospective studies, 3 prospective studies and 2 randomised control trials from a total of 11 countries. There were 1433 in the no cholecystectomy cohort (55.2%) and 1165 in the prophylactic cholecystectomy (44.8%) cohort. Cholecystectomy resulted in a decreased risk of cholecystitis (OR = 0.15; CI 0.07-0.36; p < 0.0001), cholangitis (OR = 0.51; CI 0.26-1.00; p = 0.05) and mortality (OR = 0.38; CI 0.16-0.9; p = 0.03). In addition, prophylactic cholecystectomy resulted in a significant reduction in biliary events, biliary pain and pancreatitis. CONCLUSIONS In patients undergoing CBD clearance, consideration should be given to performing prophylactic cholecystectomy to optimise outcomes.
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Affiliation(s)
- Gearóid Mc Geehan
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland.
- School of Medicine, University of Limerick, Limerick, Ireland.
| | - Conor Melly
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall O' Connor
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
| | - Gary Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Shahin Mohseni
- Department of Trauma and Emergency Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (European Union Interreg VA Funded), Magee Campus, Northern Ireland, UK
| | - Alison Johnston
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland
- Department of Surgery, Letterkenny University Hospital, Letterkenny, Co Donegal, Ireland
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland
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Stettler GR, Ganapathy AS, Bosley ME, Spencer AL, Neff LP, Nunn AM, Miller PR. Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win. Trauma Surg Acute Care Open 2023; 8:e001045. [PMID: 36726402 PMCID: PMC9884901 DOI: 10.1136/tsaco-2022-001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023] Open
Abstract
Objectives Although controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with LC with endoscopic retrograde cholangiopancreatography (ERCP) but increases case complexity/time. The influence of time of day on LCBDE outcomes has not been evaluated. Our aim was to examine outcomes and LOS for nighttime (PM) compared with daytime LC+LCBDE (DAY). Methods Consecutive patients who underwent LCBDE were reviewed. Demographics, operative duration, success of LCBDE, time to postoperative ERCP (if required), LOS, and complications were compared. PM procedures were defined as beginning 19:00-07:00 hours. Results Between 2018 and 2022, sixty patients underwent LCBDE (PM 42%). Groups had equivalent age/sex and preoperative liver function tests (LFTs). LCBDE success was 69% PM versus 71% DAY (p=0.78). Operative duration did not differ (2.8 IQR: 2.2-3.3 hours vs. 2.8 IQR: 2.3-3.2 hours, p=0.9). LOS was compared, and PM LOS was shorter (p=0.03). Time to ERCP after a failed LCBDE at night was compared with daytime (13.8 IQR: 10.6-29.5 hours vs. 19.9 IQR: 18.7-54.4 hours, p=0.07). LOS for failed PM LCBDE requiring ERCP was similar to successful DAY LCBDE (p=0.29). One complication (transient hyperbilirubinemia) was reported in the DAY group, none in PM. Conclusion PM LCBDE cases are equivalent in safety and success rate to DAY cases but have reduced LOS. Widespread adoption of acute care surgery-driven management of choledocholithiasis via LCBDE during cholecystectomy may decrease LOS, especially in PM cases. Level of evidence Level IV.
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Affiliation(s)
- Gregory R Stettler
- Department of Surgery, Division of Trauma and Acute Care Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Aravindh S Ganapathy
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Maggie E Bosley
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Audrey L Spencer
- Department of Surgery, Division of Trauma and Acute Care Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Lucas P Neff
- Department of Surgery, Division of Pediatric Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Andrew M Nunn
- Department of Surgery, Division of Trauma and Acute Care Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Preston R Miller
- Department of Surgery, Division of Trauma and Acute Care Surgery, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
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Al-Ardah MI, Barnett RE, Rotennburg H, Maitland LE, Clarke MG, Clark J, Cota AM, Peyser PM, Finlay IG. Index admission vs elective laparoscopic common bile duct exploration: a district general hospital experience over 6 years. Langenbecks Arch Surg 2023; 408:32. [PMID: 36645510 DOI: 10.1007/s00423-023-02773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/12/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) is relatively a new approach for clearing choledocholithiasis. The aim of this study is to assess the safety of this approach to clearing common bile duct (CBD) stones on an index admission including emergency setting. METHODS Retrospective data collection and analysis were carried out for 207 consecutive cases of LCBDE performed in Royal Cornwall Hospital over 6 years (2015-2020). Patients were divided into two groups (Index admission vs elective) then both groups compared. RESULTS A total of 207 cases of LCBDE were performed in our unit during the time period. One hundred twenty-two operations were performed on the index admission and 85 on a subsequent elective list. Mean operative time was 146 ± 64 min in the index admission group and 145 ± 65 min in the elective group (p = 0.913). Length of stay post-operatively was 3.3 ± 6.3 days in the index admission cases and 3.5 ± 4.6 days after elective cases. Successful clearance was achieved at the end of the operation in 116 patients in the index admission group, clearance failed in one case and negative exploration in 5 patients. In the elective group 83 patients had a successful clearance at the end of the operation, and 2 patients has had a negative exploration. Twelve patients (index admission group) and 8 patients of the elective cases required post-operative Endoscopic Retrograde Cholangiopancreatography (ERCP) to manage retained stones, recurrent stones and bile leak (p = 0.921). Three patients required re-operation for post-operative complications in each group. CONCLUSION Common bile duct exploration in index admission is safe with high success rate if performed by well-trained surgeons with advanced laparoscopic skills.
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Affiliation(s)
- Mahmoud I Al-Ardah
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK.
| | | | - Hannah Rotennburg
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Louise E Maitland
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Michael G Clarke
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - James Clark
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Allwyn M Cota
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Paul M Peyser
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
| | - Ian G Finlay
- Department of General Surgery, Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ, Cornwall, UK
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Riojas-Garza A, Morales-Morales CA, Leyva-Alvizo A, Rodríguez AH. Laparoscopic Common Bile Duct Exploration Using a Disposable Bronchoscope. Indian J Surg 2022; 85:1-4. [PMID: 36536666 PMCID: PMC9750835 DOI: 10.1007/s12262-022-03642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic common bile duct exploration (LCBDE) remains underutilized in the management of common bile duct (CBD) stones. The exact cause of this under-utilization remains unclear; however, identified barriers to LCBDE implementation include lack of training and unavailability of dedicated instruments. LCBDE is an attractive alternative for stone retrieval in patients with Roux-en-Y gastric bypass given the anatomical difficulty in endoscopic retrograde cholangiopaneatography (ERCP). Direct visualization through choledochoscopy is the method of choice for LCBDE. However, dedicated choledoscopes are expensive and not widely available, which may lead surgeons to seek for alternatives at their particular environment. With the COVID-19 pandemic, disposable bronchoscopes have become widely accessible at our institution, raising the possibility of using one for direct vision of the biliary tract. We present the case of a 61-year-old male with past medical history of Roux-en-Y gastric bypass, who presented to the emergency department with a CBD stone. Successful LCBDE was achieved with the aid of a disposable bronchoscope for direct visualization of the biliary tract. Supplementary Information The online version contains supplementary material available at 10.1007/s12262-022-03642-7.
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Affiliation(s)
- Alberto Riojas-Garza
- Departamento de Cirugía General, Escuela de Medicina y Ciencias de la Salud del Tecnológico y de Estudios Superiores de Monterrey Ignacio A. Santos, Monterrey, México
- Av. Ignacio Morones Prieto 3000, Zona Los Callejones, N.L. 64718 Monterrey, México
| | - Carlos A. Morales-Morales
- Departamento de Cirugía General, Escuela de Medicina y Ciencias de la Salud del Tecnológico y de Estudios Superiores de Monterrey Ignacio A. Santos, Monterrey, México
| | - Adolfo Leyva-Alvizo
- Departamento de Cirugía General, Escuela de Medicina y Ciencias de la Salud del Tecnológico y de Estudios Superiores de Monterrey Ignacio A. Santos, Monterrey, México
| | - Alejandro H. Rodríguez
- Departamento de Cirugía General, Escuela de Medicina y Ciencias de la Salud del Tecnológico y de Estudios Superiores de Monterrey Ignacio A. Santos, Monterrey, México
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Tamm TI, Zulfugarov IG, Nepomnyashchiy VV, Zackarchuck OP, Mamontov IM, Kramarenko KO, Rechetnyack OM. Morphological substantiation of ultrasonographic criteria of an acute cholecystitis and its paravesical complications. KLINICHESKAIA KHIRURGIIA 2022. [DOI: 10.26779/2522-1396.2022.3-4.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective. To improve quality of diagnosis of paravesical complications in patients, suffering an acute cholecystitis, using demonstration of interrelationship of changes in the gallbladder wall histostructure and its echogram data.
Materials and methods. Comparative analysis of the gallbladder wall echogram and results of the gallbladder wall morphological investigation was conducted in 520 patients with an acute cholecystitis to determine the kind of paravesical complications.
Results. Morphological investigation of the gallbladder wall have shown that the gallbladder dimensions and the wall thickness enhancement are not universal characteristic features for an acute cholecystitis. To determine the kind of its inflammation (phlegmonous, gangrenous or catarral) is also impossible. In accordance to ultrasonographic criteria an acute cholecystitis diagnosis is established, аnd patho-morphologist determines the inflammation form. Sclerotic processes with overgrowth of dense connective tissue were revealed in the gallbladder wall while presence of a long-term inflammatory process. That's why in the patients, suffering an acute cholecystitis, the gallbladder wall echograms may show excessively white signal with delineated contours, but at the same time the gallbladder volume may be not changed or even reduced. This data may impact the choice of operative procedure. Ultrasonographic signs of presence of paravesical infiltrate and abscess were established as well.
Conclusion. Echographic changes of the gallbladder wall indicates its inflammation, but do not give possibility to find which form it has. The gallbladder volume may be reduced in an acute cholecystitis, if inflammation occurs on background of recurrent process. The gallbladder wall demonstrates excessively white positive echographic signal, if in its structure connective tissue and collagen fibers prevail.
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Yang S, Wu S, Dai W, Pang L, Xie Y, Ren T, Zhang X, Bi S, Zheng Y, Wang J, Sun Y, Zheng Z, Kong J. Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery. Front Surg 2022; 9:991684. [PMID: 36248372 PMCID: PMC9562259 DOI: 10.3389/fsurg.2022.991684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds/Aims A history of upper abdominal surgery has been identified as a relative contraindication for laparoscopy. This study aimed to compare the clinical efficacy and safety of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with and without previous upper abdominal surgery. Methods In total, 131 patients with previous upper abdominal surgery and 64 without upper abdominal surgery underwent LC or LCBDE between September 2017 and September 2021 at the Shengjing Hospital of China Medical University. Patients with previous upper abdominal surgery were divided into four groups: group A included patients with previous right upper abdominal surgery who underwent LC (n = 17), group B included patients with previous other upper abdominal surgery who underwent LC (n = 66), group C included patients with previous right upper abdominal surgery who underwent LCBDE (n = 30), and group D included patients with previous other upper abdominal surgery who underwent LCBDE (n = 18). Patient demographics and perioperative outcomes were retrospectively analyzed. Results The preoperative liver function indexes showed no significant difference between the observation and control groups. For patients who underwent LC, groups A and B had more abdominal adhesions than the control group. One case was converted to open surgery in each of groups A and B. There was no statistical difference in operation time, estimated blood loss, postoperative hospital stay, and drainage volume. For patients who underwent LCBDE, groups C and D had more estimated blood loss than the control group (group C, 41.33 ± 50.84 vs. 18.97 ± 13.12 ml, p = 0.026; group D, 66.11 ± 87.46 vs. 18.97 ± 13.12 ml, p = 0.036). Compared with the control group, group C exhibited longer operative time (173.87 ± 60.91 vs. 138.38 ± 57.38 min, p = 0.025), higher drainage volume (296.83 ± 282.97 vs. 150.83 ± 127.04 ml, p = 0.015), and longer postoperative hospital stay (7.97 ± 3.68 vs. 6.17 ± 1.63 days, p = 0.021). There was no mortality in all groups. Conclusions LC or LCBDE is a safe and feasible procedure for experienced laparoscopic surgeons to perform on patients with previous upper abdominal surgery.
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Affiliation(s)
- Shaojie Yang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuodong Wu
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Liwei Pang
- Breast Surgery Unit, Department of General Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yaofeng Xie
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tengqi Ren
- Department of Urinary Surgery, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China
| | - Xiaolin Zhang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyuan Bi
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuting Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jingnan Wang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Sun
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuyuan Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Jing Kong
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Lagouvardou E, Martines G, Tomasicchio G, Laforgia R, Pezzolla A, Caputi Iambrenghi O. Laparo-endoscopic management of chole-choledocholithiasis: Rendezvous or intraoperative ERCP? A single tertiary care center experience. Front Surg 2022; 9:938962. [PMID: 36117813 PMCID: PMC9470774 DOI: 10.3389/fsurg.2022.938962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The management of chole-choledocholithiasis remains a matter of debate to preserve minimal invasive management and different options have been proposed, with single- or two-stage approaches. Two techniques of single-stage approach are intraoperative ERCP and laparoscopic rendezvous, which have the great advantage of reducing the length of hospital stay with increased patient compliance. This retrospective study aims to evaluate and compare the efficacy and safety of intraoperative ERCP and rendezvous technique for more than 15 years. Materials and methods Clinical records of 113 patients who underwent single-stage management for chole-choledocholithiasis between January 2003 and December 2020 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with intraoperative ERCP and those with rendezvous, and their intraoperative and postoperative parameters were compared. All patients were followed up for 6 months in an outpatient setting. Results A total of 68 (60%) patients were treated with intraoperative ERCP, while the remaining 45 (40%) were treated with rendezvous. There were no significant differences in terms of comorbidities. ERCP was performed with a median operative time of 145 min (104–168) and an endoscopic time of 27 min (15–36). Meanwhile, rendezvous was performed with a significantly lower operative [120 min (94–147)] and endoscopic time [15 min (12–22)]. No intraoperative complications were recorded. Patients treated with rendezvous had a significantly shorter median hospitality stay [4 (3–5) vs. 3 (2–4) days, p < 0.05]. No hospital readmissions or mortalities were observed in either group after 30 days. Ten mild pancreatitis cases were observed, mainly in the intraoperative ERCP group (9 vs. 1, p < 0.05), and all were treated conservatively. Only two patients treated with intraoperative ERCP developed biliary complications later on. Conclusion Laparoscopic rendezvous should be considered a preferable alternative to intraoperative ERCP for the treatment of patients with concomitant CBD stones and gallstones.
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Affiliation(s)
| | - Gennaro Martines
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
- Correspondence: Giovanni Tomasicchio
| | - Rita Laforgia
- Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Angela Pezzolla
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Onofrio Caputi Iambrenghi
- Department of Emergency and Organ Transplantation, School of Medicine, University of Bari Aldo Moro, Bari, Italy
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12
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Zhang R, Liu J, Li H, Zeng Q, Wu S, Tian H. Evaluation of therapeutic efficacy, safety and economy of ERCP and LTCBDE in the treatment of common bile duct stones. Front Physiol 2022; 13:949452. [PMID: 36091409 PMCID: PMC9452837 DOI: 10.3389/fphys.2022.949452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study further compared the endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic transcystic common bile duct exploration (LTCBDE) approaches in the treatment of common bile duct stones (CBDS) from the perspective of efficacy, safety and economy.Methods: The therapeutic efficacy and safety of ERCP and LTCBDE approaches were retrospectively compared. Cost-effectiveness analysis of clinical economics was performed to analyze and evaluate the two approaches.Results: There was no significant difference in the success rate of surgery and bile stone residue between ERCP and LTCBDE group. The incidence of postoperative complications in ERCP group was significantly higher than that in the LTCBDE group; while the incidence of pancreatitis in the ERCP group was significantly higher than that in the LTCBDE group. There was no significant difference in biliary infection, bile leakage and sepsis between ERCP and LTCBDE groups. In terms of cost, the costs of surgery and nursing were significantly lower, the costs of treatment and sanitary materials were significantly higher in the ERCP group than that in the LTCBDE group. There was no significant difference in the costs of medical examination, laboratory test, medicine cost and total cost between ERCP group and LTCBDE group. The total length of hospital stay, length of hospital stay before surgery and duration of surgery in the ERCP group were significantly lower than that in the LTCBDE group; there was no significant difference in length of hospital stay after surgery between the ERCP and LTCBDE group. The cost-effectiveness ratio of ERCP group was 34171.25, and the cost-effectiveness of LTCBDE group was 34524.25. The incremental cost-effectiveness ratio (ICER) of the two groups was 51415.Conclusion: ERCP and LTCBDE approaches had similar therapeutic efficacy in the treatment of CBDS. The safety of LTCBDE approach is superior to that of ERCP approach for the treatment of CBDS. ERCP approach is more economical in the treatment of CBDS than LTCBDE approach.
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Affiliation(s)
- Renjie Zhang
- Department of Hepatobiliary Surgery, Shenzhen Traditional Chinese Medicine Hospital/The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jialin Liu
- Department of Hepatobiliary Surgery, Shenzhen Traditional Chinese Medicine Hospital/The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Huizhen Li
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Qingteng Zeng
- Department of Hepatobiliary Surgery, Shenzhen Traditional Chinese Medicine Hospital/The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Shenfeng Wu
- Department of Hepatobiliary Surgery, Shenzhen Traditional Chinese Medicine Hospital/The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hengyu Tian
- Department of Hepatobiliary Surgery, Shenzhen Traditional Chinese Medicine Hospital/The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- *Correspondence: Hengyu Tian,
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13
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Robinson C, Turner RM, Potter J. A retrospective analysis of magnetic resonance cholangiopancreatography investigating gallstones in a contemporary surgical setting. ANZ J Surg 2022; 92:2174-2179. [PMID: 35766431 PMCID: PMC9544053 DOI: 10.1111/ans.17875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/03/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS The New Zealand Public Health System operates in a resource limited environment. Pre-operative investigation of choledocholithiasis (CDL) is variable. Protocol driven practice has improved patient outcomes and cost-effectiveness. The aim is to explore risk stratification for CDL and specific thresholds for accessing magnetic resonance cholangiopancreatography (MRCP) in this contemporary setting. METHODS All adult (16+ years) acute inpatient MRCP requests for gallstone work-up between 1 Jan 2018 and 2031 Dec 2019 at Dunedin Hospital were included. Patients with characteristics not in fitting with an acute symptomatic examination were excluded. Receiver operating characteristic curves were estimated for bilirubin versus MRCP positive by the presence/absence of dilated ducts, indication and American Society of Gastrointestinal Endoscopy (ASGE) risk grouping. RESULTS A 106 patients were included. Mean bilirubin at presentation and time of MRCP, 47 versus 28 μmol/L, respectively. MRCP confirmed CDL in 39 (37%) patients. 38 (97%) had biochemical changes with choledocholithiasis. 21 (40%) with CBD dilation had ductal stones versus 18 (34%) with normal ducts. ASGE risk stratification showed 36 (34%), 66 (62%) and 4 (4%) were high, intermediate and low risk, respectively. Of these groups 44%, 35% and 0% had CBD stones on MRCP, respectively. Combination thresholds involving duct size and bilirubin can yield negative predictive values >90%, substantially reducing MRCP load. CONCLUSIONS MRCP requests can be triaged to maximize stones detected without overly increasing the rate of missed duct stones whilst protecting the limited MRI and ERCP resources. International thresholds and risk stratification alone may not be applicable in our resource limited environment.
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Affiliation(s)
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Jon Potter
- Surgical Department, Dunedin Hospital, Dunedin, New Zealand
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14
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Isaza-Gómez E, Velásquez-Martínez MA, Camilo Andrés Díaz-Quintero CA, Molina-Céspedes IC, Salazar-Ochoa S, Posada-Moreno P, Chanci-Drago R, Guzmán-Arango N. Controversias en cirugía: colelitiasis y coledocolitiasis ¿Exploración de vías biliares laparoscópica más colecistectomía laparoscópica (cirugía en un paso) o CPRE y colecistectomía laparoscópica (cirugía en dos pasos)? REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La colelitiasis tiene una prevalencia del 15 % y el 21 % tendrá coledocolitiasis al momento de la colecistectomía, con 50 % de probabilidad de presentar complicaciones asociadas. Desde el advenimiento de la colecistectomía laparoscópica, el abordaje de la coledocolitiasis ha sido endoscópico, usualmente en un tiempo diferente al vesicular, sin embargo, los avances en laparoscopia han permitido explorar la vía biliar común por la misma vía, pudiendo realizar ambos procedimientos en el mismo tiempo de forma segura.
Métodos. Se realizó una búsqueda de la literatura existente con relación al enfoque para el manejo de la colecistocoledocolitasis en un paso comparado con dos pasos.
Resultados. Existe evidencia que demuestra mayor efectividad del abordaje en dos pasos, con CPRE y posterior colecistectomía laparoscópica, sobre el abordaje en un paso, especialmente en la tasa de fuga biliar y de cálculos retenidos. El enfoque en un paso con exploración de vías biliares y colecistectomía laparoscópica en el mismo tiempo es seguro, con alta tasa de éxito, baja incidencia de complicaciones, menor estancia hospitalaria y costos.
Conclusión. El abordaje laparoscópico en un solo paso es un procedimiento seguro y eficaz para el manejo de la colecisto-coledocolitiasis, con el beneficio de estancia hospitalaria menor, sin embargo, se requieren habilidades técnicas avanzadas en cirugía laparoscópica. En nuestro medio ya existe una infraestructura para el manejo híbrido con CPRE y colecistectomía laparoscópica, pudiéndose realizar ambos en el mismo tiempo, para reducir estancia y costos.
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15
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Li Q, Chen L, Liu S, Chen D. Comparison of Laparoscopic Common Bile Duct Exploration with Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones After Cholecystectomy. J Laparoendosc Adv Surg Tech A 2022; 32:992-998. [PMID: 35363577 DOI: 10.1089/lap.2021.0871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Few studies have focused on the treatment of common bile duct (CBD) stones after cholecystectomy, for which optimal treatment options remain unclear. Aims: To compare the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) versus endoscopic retrograde cholangiopancreatography (ERCP) for CBD stone treatment after cholecystectomy. Materials and Methods: A total of 201 patients were enrolled in this retrospective cohort study, of whom 134 with ≤3 stones and a maximum stone diameter of <15 mm were classified as subgroup 1, and 67 with >3 stones or a maximum stone diameter of ≥15 mm were classified as subgroup 2. Perioperative characteristics were also analyzed. Results: ERCP subgroup 1 exhibited a shorter operative time (P < .001), postoperative hospital stay (P < .001), and lower incidence of bile leakage (P = .034) than LCBDE subgroup 1. ERCP subgroup 2 exhibited a shorter operative time (P < .001) and shorter postoperative hospital stay (P < .001) than LCBDE subgroup 2. However, LCBDE subgroup 2 exhibited a greater rate of complete stone removal (P = .044) and a lower incidence of acute pancreatitis (P = .037) than ERCP subgroup 2. Conclusions: For treatment of CBD stones after cholecystectomy, ERCP was superior in cases involving ≤3 stones and a maximum stone diameter of <15 mm. Among those with >3 stones or maximum stone diameter of ≥15 mm, LCBDE demonstrated certain advantages.
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Affiliation(s)
- Qinghua Li
- Department of Hepatopancreatobiliary Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
| | - Lu Chen
- Department of Hepatopancreatobiliary Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
| | - Shuanghai Liu
- Department of Hepatopancreatobiliary Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
| | - Dawei Chen
- Department of Hepatopancreatobiliary Surgery, Jiangyin People's Hospital Affiliated to Nantong University, Jiangyin, China
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16
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Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. Improving the algorithm for diagnosing patients with postcholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP).
Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin.
The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used.
Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater's nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions.
Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques.
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17
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Vu AN, Eskander J, Chan STF, Houli N, Bui HT. Impact of single-stage laparoscopic trans-cystic exploration on hospital procedures, admissions and length-of-stay in common bile duct stone clearance. ANZ J Surg 2021; 91:2695-2700. [PMID: 34608735 DOI: 10.1111/ans.17255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Single-stage approach with bile duct exploration is considered the most efficient and cost-effective method of bile duct clearance. In Australia, apart from centres with subspecialty interests, notably in Brisbane, Queensland, a multi-stage approach with endoscopic retrograde cholangiopancreatography (ERCP) is used more frequently. We aim to evaluate the impact of single stage laparoscopic trans-cystic exploration (LTCE) versus multi-stage approach for choledocholithiasis. METHODS This was a retrospective cohort study. Medicare Benefits Schedule codings were used to identify patients who had the following procedures between December 2011 and December 2019: laparoscopic cholecystectomy (LC) and ERCP, LC and LTCE, LC and LTCE and ERCP. Primary outcomes were number of hospital procedures, admissions and additive length of stay (aLOS), the cumulative hospital stay from admission to discharge. RESULTS Of 607 patients, 204 (34%) patients received a single-stage LTCE, while 403 (66%) patients had a multi-stage approach. In the LTCE group, 82% (168) patients and 93% (190) patients had one procedure and one admission respectively for stone clearance (P = 0.001). The median aLOS was 4 days for LTCE versus 7 days for multi-stage approach (P = 0.001; 95% CI for difference - 3 to -2). In the multi-stage group, 16% (65) patients had three or more procedures and 49% (199) patients required two or more hospital admissions to achieve stone clearance. CONCLUSION LTCE for stone clearance can be successfully accomplished with reductions in hospital admissions, number of procedures and length of stay. This has further economic and health resource implications.
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Affiliation(s)
- Anh N Vu
- Department of Surgery, (Upper-Gastrointestinal/Hepato-Pancreato-Biliary Unit) Western Health, Melbourne, Australia
| | - Jacqueline Eskander
- Department of Surgery, (Upper-Gastrointestinal/Hepato-Pancreato-Biliary Unit) Western Health, Melbourne, Australia
| | - Steven T F Chan
- Department of Surgery, (Upper-Gastrointestinal/Hepato-Pancreato-Biliary Unit) Western Health, Melbourne, Australia.,Department of Surgery, Western Precinct, The University of Melbourne, Melbourne, Australia
| | - Nezor Houli
- Department of Surgery, (Upper-Gastrointestinal/Hepato-Pancreato-Biliary Unit) Western Health, Melbourne, Australia
| | - Hai T Bui
- Department of Surgery, (Upper-Gastrointestinal/Hepato-Pancreato-Biliary Unit) Western Health, Melbourne, Australia.,Department of Surgery, Western Precinct, The University of Melbourne, Melbourne, Australia
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18
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Ng HJ, Nassar AHM. Reinterventions following laparoscopic cholecystectomy and bile duct exploration. A review of prospective data from 5740 patients. Surg Endosc 2021; 36:2809-2817. [PMID: 34076762 PMCID: PMC9001563 DOI: 10.1007/s00464-021-08568-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 01/24/2023]
Abstract
Background Complications following laparoscopic cholecystectomy (LC) and common bile duct exploration (CBDE) for the management of gallstones or choledocholithiasis impact negatively on patients’ quality of life and may lead to reinterventions. This study aims to evaluate the causes and types of reintervention following index admission LC with or without CBDE. Methods A prospectively maintained database of LC and CBDE performed by a single surgeon was analysed. Preoperative factors, difficulty grading and perioperative complications requiring reintervention and readmissions were examined. Results Reinterventions were required in 112 of 5740 patients (2.0%), 89 (1.6%) being subsequent to complications. The reintervention cohort had a median age of 64 years, were more likely to be females (p < 0.0023) and to be emergency admissions (67.9%, p < 0.00001) with obstructive jaundice (35.7%, p < 0.00001). 46.4% of the reintervention cohort had a LC operative difficulty grade IV or V and 65.2% underwent a CBDE. Open conversion was predictive of the potential for reintervention (p < 0.00001). The most common single cause of reintervention was retained stones (0.5%) requiring ERCP followed by bile leakage (0.3%) requiring percutaneous drainage, ERCP and relaparoscopy. Relaparoscopy was necessary in 17 patients and open surgery in 13, 6 of whom not resulting from complications. There were 5 deaths. Conclusion This large series had a low incidence of reinterventions resulting from complications in spite of a high workload of index admission surgery for biliary emergencies and bile duct stones. Surgical or endoscopic reinterventions following LC alone occurred in only 0.8%. The most common form of reintervention was ERCP for retained CBD stones. This important outcome parameter of laparoscopic biliary surgery can be optimised through early diagnosis and timely reintervention for complications.
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Affiliation(s)
- Hwei Jene Ng
- Laparoscopic Biliary Surgery Service, University Hospital Monklands, Airdrie, Scotland, UK
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19
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Romero RJ, Martinez-Mier G, Ayala-García MA, Beristain-Hernández JL, Chan-Nuñez LC, Chapa-Azuela O, Dominguez-Rosado I, Flores-Villalba E, Fuentes-Orozco C, García-Covarrubias L, González-Ojeda A, Herrera-Hernández MF, Martinez-Ordaz JL, Medina-Franco H, Mercado MA, Montalvo-Jave E, Nuño-Guzmán CM, Torices-Escalante E, Torres-Villalobos GM, Vilatoba-Chapa M, Zamora-Godinez J, Zapata-Chavira H, Zerrweck-Lopez C. Establishing consensus on the perioperative management of cholecystectomy in public hospitals: a Delphi study with an expert panel in Mexico. HPB (Oxford) 2021; 23:685-699. [PMID: 33071151 DOI: 10.1016/j.hpb.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/16/2020] [Accepted: 09/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several guidelines have put forward recommendations about the perioperative process of cholecystectomy. Despite the recommendations, controversy remains concerning several topics, especially in low- and middle-income countries. The aim of this study was to develop uniform recommendations for perioperative practices in cholecystectomy in Mexico to standardize this process and save public health system resources. METHODS A modified Delphi method was used. An expert panel of 23 surgeons anonymously completed two rounds of responses to a 29-item questionnaire with 110 possible answers. The consensus was assessed using the percentage of responders agreeing on each question. RESULTS From the 29 questions, the study generated 27 recommendations based on 20 (69.0%) questions reaching consensus, one that was considered uncertain (3.4%), and six (20.7%) items that remained open questions. In two (6.9%) cases, no consensus was reached, and no recommendation could be made. CONCLUSIONS This study provides recommendations for the perioperative management of cholecystectomy in public hospitals in Mexico. As a guide for public institutions in low- and middle-income countries, the study identifies recommendations for perioperative tests and evaluations, perioperative decision making, postoperative interventions and institutional investment, that might ensure the safe practice of cholecystectomy and contribute to conserving resources.
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Affiliation(s)
- Rey Jesus Romero
- Department of Bariatric & Metabolic Surgery, Spanish Hospital of Veracruz, 16 de Septiembre 955 Col. Centro, 91700, Veracruz, Ver., Mexico.
| | - Gustavo Martinez-Mier
- Department of Hepato-Biliary Surgery & Transplantation, High Speciality Medical Unit 14, Mexican Institute of Social Security, Cuahutémoc Col. Formando Hogar, 91810, Veracruz, Ver., Mexico
| | - Marco A Ayala-García
- Department of Surgery & Research, General Hospital Zone 58, Mexican Institute of Social Security, Boulevard Jorge Vértiz Campero 1949 Col, San Miguel de Rentería, 37238, León, Gto., Mexico
| | - Jose Luis Beristain-Hernández
- Department of Hepato-Biliary Surgery, National Medical Center "Antonio Fraga Mouret, La Raza", Seris y Zaachila Col. La Raza, 02990, Mexico City, Mexico
| | - Luis Carlos Chan-Nuñez
- Department of Hepato-Biliary Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Oscar Chapa-Azuela
- Department of Hepato-Pancreato-Biliary Surgery, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmis 148 Col. Doctores, 06720, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Department of Hepato-Biliary Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Eduardo Flores-Villalba
- Department of Hepato-Biliary Surgery & Transplantation, Zambrano Hellion Medical Center Monterrey Institute of Technology and Higher Education, Batallón de San Patricio 112 Col. Real San Agustín, 66278, San Pedro Garza García, N.L., Mexico
| | - Clotilde Fuentes-Orozco
- Department of Surgery & Research, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez 1000 Col. Belisario Dominguez, 44329, Guadalajara, Jal., Mexico
| | - Luis García-Covarrubias
- Department of Transplantation, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmis 148 Col. Doctores, 06720, Mexico City, Mexico
| | - Alejandro González-Ojeda
- Department of Surgery & Research, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez 1000 Col. Belisario Dominguez, 44329, Guadalajara, Jal., Mexico
| | - Miguel Francisco Herrera-Hernández
- Department of Endocrine Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - José Luis Martinez-Ordaz
- Department of Surgery, XXI Century National Medical Center, Mexican Institute of Social Security, Av. Cuahutémoc 33 Col. Doctores, 06720, Mexico City, Mexico
| | - Heriberto Medina-Franco
- Department of Surgical Oncology, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Miguel Angel Mercado
- Department of Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Eduardo Montalvo-Jave
- Department of Hepato-Pancreato-Biliary Surgery, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmis 148 Col. Doctores, 06720, Mexico City, Mexico
| | - Carlos Martine Nuño-Guzmán
- Department of Surgery, Civil Hospital "Fray Antonio Alcalde", Hospital 278 Col. El Retiro, 44280, Guadalajara, Jal., Mexico
| | - Eduardo Torices-Escalante
- Department of Gastrointestinal Endoscopy, Regional Hospital October 1st, Institute for Social Security and Services for State Workers, Av. Politécnico Nacional 1669 Col. Magdalena de las Salinas, 07300, Mexico City, Mexico
| | - Gonzalo Manuel Torres-Villalobos
- Department of Experimental Surgery & Minimally Invasive Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Mario Vilatoba-Chapa
- Department of Transplantation, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiróga 15 Col. Belisario Dominguez, 14080, Mexico City, Mexico
| | - Jordán Zamora-Godinez
- Department of Surgery, General Hospital Zone 8, Mexican Institute of Social Security, Calle 18 de julio 214 Col. Periodistas, 42060, Pachuca, Hgo., Mexico
| | - Homero Zapata-Chavira
- Department of Surgery & Transplantation, University Hospital "Dr. José E. González", Av. Gonzalitos 235 Col. Mitras Centro, 64460, Monterrey, N.L., Mexico
| | - Carlos Zerrweck-Lopez
- Department of Bariatric & Metabolic Surgery, Tláhuac General Hospital, Av. La Turba 655 Col. Villa Centroamericana, 13250, Mexico City, Mexico
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Cortez AR, Potts JR. Resident Education in Biliary Operation: Beyond Laparoscopic Cholecystectomy. J Am Coll Surg 2021; 232:1020-1021. [PMID: 33849747 DOI: 10.1016/j.jamcollsurg.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
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Marks B, Al Samaraee A. Laparoscopic Exploration of the Common Bile Duct: A Systematic Review of the Published Evidence Over the Last 10 Years. Am Surg 2020; 87:404-418. [PMID: 33022185 DOI: 10.1177/0003134820949527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Endoscopic and open surgical interventions are widely implemented as the standard practice in common bile duct exploration. However, the laparoscopic approach has been also reported to have comparative/superior outcomes in this concept. This has created an ongoing debate about the ideal approach to adopt in practice. METHODS A systematic review of the published evidence over the last decade that has looked into the outcomes of laparoscopic exploration of the common bile duct through transductal and transcystic approaches. RESULTS Our systematic review included 36 relevant papers. The majority were based on nonrandomized protocols conducted in single centers with high expertise. The data analysis showed that laparoscopic common bile duct exploration through both approaches was successful in more than 84% of the patients, with an average length of hospital stay of 5.6 days. Conversion to open surgery was reported in 5%-8% of the patients, and the bile leak rates from the more recent studies was 0%-12%, with mortality figures of 0%-1.3%. The outcomes were statistically in favor of the transcystic route when compared to the transductal route from the viewpoints of bile leak rates, mean operative time, duration of hospital stay and morbidity. CONCLUSION In experienced hands, both laparoscopic approaches in common bile duct exploration are safe in patients who are clinically fit to have this intervention. It is associated with a statistically significant lower overall morbidity and shorter duration of hospital stay when compared to open surgery. Relevant up-to-date high-quality randomized trials are unavailable.
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Affiliation(s)
- Bertram Marks
- 3482 Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Ahmad Al Samaraee
- 1333 Ashford and St. Peter's Hospitals NHS Foundation Trust, Chertsey, United Kingdom
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Cortez AR, Potts JR. More of less: General Surgery Resident Experience in Biliary Surgery. J Am Coll Surg 2020; 231:33-42. [DOI: 10.1016/j.jamcollsurg.2020.02.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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Tracy BM, Paterson CW, Torres DM, Young K, Hochman BR, Zielinski MD, Burruss SK, Mulder MB, Yeh DD, Gelbard RB. Risk factors for complications after cholecystectomy for common bile duct stones: An EAST multicenter study. Surgery 2020; 168:62-66. [PMID: 32466829 DOI: 10.1016/j.surg.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND We sought to prospectively identify risk factors for biliary complications and 30-day readmission after cholecystectomy for choledocholithiasis and gallstone pancreatitis across multiple US hospitals. METHODS We performed a prospective, observational study of patients who underwent same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019 at 12 US centers. Patients with prior history of endoscopic retrograde cholangiopancreatography or diagnosis of cholangitis were excluded. We used logistic regression to determine associations between preoperative demographics, labs, and imaging on primary outcomes: postoperative biliary complications and 30-day readmission. RESULTS There were 989 patients in the cohort. There were 16 (1.6%) patients with postoperative biliary complications, including intra-abdominal abscesses, endoscopic retrograde cholangiopancreatography-induced pancreatitis, and biliary leaks. Increasing operative time (odds ratio 1.01, 95% confidence interval 1.00-1.01, P = .02), worsening leukocytosis (odds ratio 1.16, 95% confidence interval 1.07-1.25, P = .0002), and jaundice (odds ratio 3.25, 95% confidence interval 1.01-10.42, P = .04) were associated with postoperative biliary complications. There were 36 (3.6%) patients readmitted within 30 days owing to a surgical complication. A prior postoperative biliary complication (odds ratio 7.8, 95% confidence interval 1.63-37.27, P = .01), male sex (odds ratio 2.42, 95% confidence interval 1.2-4.87, P = .01), and index operative duration (odds ratio 1.01, 95% confidence interval 1.00-1.01, P = .03) were associated with 30-day readmission. CONCLUSION Among patients undergoing cholecystectomy for common bile duct stones, jaundice, worsening leukocytosis, and longer operations are associated with postoperative biliary complications. A prior biliary complication is also predictive of a 30-day readmission. Surgeons should recognize these factors and avoid prematurely discharging at-risk patients given their propensity to develop complications and require readmission.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, Emory University School of Medicine, Atlanta, GA; Emory Department of Surgery, Grady Memorial Hospital, Atlanta, GA.
| | - Cameron W Paterson
- Department of Surgery, Emory University School of Medicine, Atlanta, GA; Emory Department of Surgery, Grady Memorial Hospital, Atlanta, GA
| | - Denise M Torres
- Department of Surgery, Geisinger Medical Center, Danville, PA
| | - Katelyn Young
- Department of Surgery, Geisinger Medical Center, Danville, PA
| | - Beth R Hochman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Martin D Zielinski
- Department of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN
| | - Sigrid K Burruss
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA
| | | | | | - Rondi B Gelbard
- Department of Surgery, Emory University School of Medicine, Atlanta, GA; Emory Department of Surgery, Grady Memorial Hospital, Atlanta, GA
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Zhou Y, Zha WZ, Fan RG, Jiang GQ, Wu XD. Two-stage versus single-stage procedure for the management of cholecystocholedocholithiasis in elderly patients: a retrospectively cohort study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:176-181. [PMID: 30507246 DOI: 10.17235/reed.2018.5822/2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND there is an increasing incidence rate of cholecysto-choledocholithiasis associated with the increasing proportion of senile individuals. METHODS a total of 100 elderly patients (over 80 years of age) suffering both from cholelithiasis and choledocholithiasis were retrospectively studied from January 2010 to December 2016. Patients were scheduled for either a single-stage or two-stage procedure. The LCBDE group (n = 54) included cases that underwent a single stage procedure of laparoscopic exploration of the common bile duct combined with cholecystectomy. The ERCP/EST group (n = 46) included cases that underwent a two stage procedure of preoperative endoscopic retrograde cholangiopancreaticography with endoscopic sphincterotomy followed by cholecystectomy. Comorbidity conditions, presenting symptoms, bile duct clearance, length of hospital stay and the frequency of procedural, postoperative and long-term complications were recorded. RESULTS the LCBDE group had a higher stones clearance rate than the ERCP/EST group (100.0% vs 89.1%, p < 0.05). Postoperative complications and hospitalization length were comparable in the two groups (p > 0.05). There were more procedural complications in the ERCP/EST group than in the LCBDE group (10.8% vs 0%, p < 0.05). Furthermore, a patient in the ERCP/EST group died due to duodenal perforation. More patients in the ERCP/EST group experienced long-term complications than those in the LCBDE group (23.9% vs 3.7%, p < 0.05) during a mean follow-up period of 28.4 months. CONCLUSIONS the single-stage procedure is a safe and effective technique for elderly patients with cholecysto-choledocholithiasis. LCBDE provides a good stone clearance rate with few long term complications.
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Affiliation(s)
- Yong Zhou
- General Surgery, Yancheng City NO.1 People's Hospital, china
| | | | | | - Guo-Qin Jiang
- The Second Affiliated of Hospital of Soochow University
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Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations. Surg Endosc 2020; 34:1551-1560. [PMID: 32072280 PMCID: PMC7093335 DOI: 10.1007/s00464-020-07429-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/10/2020] [Indexed: 12/30/2022]
Abstract
Background A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery. Methods We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups. Results The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5–700) vs. 50 (10–1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3–78) vs. 8.5 (4.5–74) days; p = 0.041], and time to oral intake [2.5 (1–7) vs. 3 (2–24) days; p = 0.015]. There were no significant differences in the operation time [170 (60–480) vs. 180 (41–330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien’s classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively). Conclusion LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery.
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Czerwonko ME, Pekolj J, Uad P, Mazza O, Sanchez-Claria R, Arbues G, de Santibañes E, de Santibañes M, Palavecino M. Laparoscopic Transcystic Common Bile Duct Exploration in the Emergency Is as Effective and Safe as in Elective Setting. J Gastrointest Surg 2019; 23:1848-1855. [PMID: 30421117 DOI: 10.1007/s11605-018-4029-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/22/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Emergent laparoscopic transcystic common bile duct exploration (LTCBDE) has been reported to be on the increase in some institutions, reflecting the growing confidence with the technique. However, no study has focused on the outcomes of LTCBDE in the non-elective setting. The aim of this study is to investigate whether LTCBDE can be performed effectively and safely in the emergency. METHODS This is a retrospective study of 500 consecutive patients with choledocholithiasis subjected for LTCBDE at the Hospital Italiano de Buenos Aires from January 2009 to January 2018. Procedures were classified according to the setting as emergent or elective. Demographic data and perioperative parameters were compared between groups. RESULTS Throughout the period comprised, 500 patients were admitted for choledocholithiasis and gallstones. A single-step treatment combining LTCBDE and laparoscopic cholecystectomy was attempted: 211 (42.2%) were performed electively and the 289 (57.8%) as an emergency. There was no significant difference in the success rate of LTCBDE (93.9% versus 93.8%, p = 0.975) for the two groups. The operative time was slightly longer in the emergency group (122 ± 63 versus 106 ± 53 min, p = 0.002). Postoperative recovery was slower in the emergency group, as reflected by a higher rate of prolonged postoperative stay (21.1% vs 5.7%, p < .001). The rates of postoperative complications were similar between groups (2.8% vs 5.9%, p = 0.109). CONCLUSION Emergent LTCBDE can be performed with equivalent efficacy and morbidity when compared to an elective procedure. Patients undergoing emergent procedures have longer procedures and hospital stays.
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Affiliation(s)
- Matias E Czerwonko
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Pedro Uad
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez-Claria
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín Palavecino
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina.
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Yang T, Ma Z, Xu B, Sun W, Meng H, Liu D, Zhou B, Song Z. Clinical role of frequency-doubled double-pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration. ANZ J Surg 2019; 89:E358-E362. [PMID: 31441206 DOI: 10.1111/ans.15364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The optimal methods for patients with difficult biliary stones remain under debate. The aim of this study was to evaluate the role of frequency-doubled double-pulse neodymium YAG (FREDDY) laser lithotripsy for removing difficult biliary stones during laparoscopic common bile duct exploration (LCBDE). METHODS Between March 2013 and January 2015, 42 consecutive patients with difficult biliary stones who underwent LCBDE with FREDDY laser lithotripsy were included in this study. The clinical data of all patients were retrospectively collected and analysed. RESULTS Bile ducts were completely cleared in all patients. The complications related to laser lithotripsy were not noted. A total of 38 patients (90.5%) underwent primary closure of common bile duct, and T-tube drainage was applied to four patients (9.5%). No bile duct injury, bleeding and perforation were observed. There were no post-operative surgery-related deaths. Bile leakage occurred in four patients (9.5%) with primary closure procedure, and all of them were managed successfully with conservative therapy. The median follow-up period was 42.8 months, with no evidence of bile duct stricture and stone recurrence in all patients. CONCLUSIONS The LCBDE combined with FREDDY laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.
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Affiliation(s)
- Tingsong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhilong Ma
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Bin Xu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Hongbo Meng
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Dalu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China.,Department of General Surgery, Shanghai Clinical Medical College of Anhui Medical University, Shanghai, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
| | - Zhenshun Song
- Department of Hepatobiliary and Pancreatic Surgery, Cholelithiasis Treatment Center, Shanghai Tenth People's Hospital, Tongji University of Medicine, Shanghai, China
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Zhang W, Wang BY, Du XY, Fang WW, Wu H, Wang L, Zhuge YZ, Zou XP. Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol 2019; 25:1002-1011. [PMID: 30833805 PMCID: PMC6397721 DOI: 10.3748/wjg.v25.i8.1002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A clinical pathway (CP) is a standardized approach for disease management. However, big data-based evidence is rarely involved in CP for related common bile duct (CBD) stones, let alone outcome comparisons before and after CP implementation.
AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography (ERCP).
METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017. The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care (non-pathway group, n = 467) and CP care (pathway group, n = 2196).
RESULTS At baseline, the main differences observed between the two groups were the percentage of patients with multiple stones (P < 0.001) and incidence of cholangitis complication (P < 0.05). The percentage of antibiotic use and complications in the CP group were significantly less than those in the non-pathway group [adjusted odds ratio (OR) = 0.72, 95% confidence interval (CI): 0.55-0.93, P = 0.012, adjusted OR = 0.44, 95%CI: 0.33-0.59, P < 0.001, respectively]. Patients spent lower costs on hospitalization, operation, nursing, medication, and medical consumable materials (P < 0.001 for all), and even experienced shorter length of hospital stay (LOHS) (P < 0.001) after the CP implementation. No significant differences in clinical outcomes, readmission rate, or secondary surgery rate were presented between the patients in the non-pathway and CP groups.
CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS, hospital costs, antibiotic use, and complication rate.
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Affiliation(s)
- Wei Zhang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Bing-Yi Wang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Xiao-Yan Du
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Wei-Wei Fang
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd. Beijing 100101, China
| | - Han Wu
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Lei Wang
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yu-Zheng Zhuge
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Ping Zou
- Department of Gastroenterology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Czerwonko ME, Pekolj J, Uad P, Mazza O, Sanchez-Claria R, Arbues G, de Santibañes E, de Santibañes M, Palavecino M. Acute Pancreatitis After Laparoscopic Transcystic Common Bile Duct Exploration: An Analysis of Predisposing Factors in 447 Patients. World J Surg 2018; 42:3134-3142. [PMID: 29616319 DOI: 10.1007/s00268-018-4611-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In laparoscopic transcystic common bile duct exploration (LTCBDE), the risk of acute pancreatitis (AP) is well recognized. The present study assesses the incidence, risk factors, and clinical impact of AP in patients with choledocholithiasis treated with LTCBDE. METHODS A retrospective database was completed including patients who underwent LTCBDE between 2007 and 2017. Univariate and multivariate analyses were performed by logistic regression. RESULTS After exclusion criteria, 447 patients were identified. There were 70 patients (15.7%) who showed post-procedure hyperamylasemia, including 20 patients (4.5%) who developed post-LTCBDE AP. Of these, 19 were edematous and one was a necrotizing pancreatitis. Patients with post-LTCBDE AP were statistically more likely to have leukocytosis (p < 0.004) and jaundice (p = 0.019) before surgery and longer operative times (OT, p < 0.001); they were less likely to have incidental intraoperative diagnosis (p = 0.031) or to have biliary colic as the reason for surgery (p = 0.031). In the final multivariate model, leukocytosis (p = 0.013) and OT (p < 0.001) remained significant predictors for AP. Mean postoperative hospital stay (HS) was significantly longer in AP group (p < 0.001). CONCLUSION The risk of AP is moderate and should be considered in patients with preoperative leukocytosis and jaundice and exposed to longer OT. AP has a strong impact on postoperative HS.
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Affiliation(s)
- Matias E Czerwonko
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Pedro Uad
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Rodrigo Sanchez-Claria
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina
| | - Martín Palavecino
- Department of General Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina.
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Platt T, Smith K, Nixon M, Sinha S, Srinivas G, Andrews S. Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series. Ann Med Surg (Lond) 2018; 36:173-177. [PMID: 30505436 PMCID: PMC6249395 DOI: 10.1016/j.amsu.2018.10.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 01/14/2023] Open
Abstract
Background Laparoscopic common bile duct exploration (LCBDE) is gaining popularity over endoscopic retrograde cholangiopancreatography (ERCP) for the management of common bile duct stones. However, its application has been almost exclusively following preoperative stone confirmation via magnetic retrograde cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) or ERCP. We present our series of LCBDE following detection of common bile duct stones with intraoperative imaging (IOI) alone, in consecutive elective and emergency patients with suspected choledocholithiasis. Materials and methods All patients with suspected but unconfirmed choledocholithiasis undergoing LC with intention to proceed to LCBDE between January 2015 and June 2017 were included. LCBDE was performed following the discovery of choledocholithiasis on IOI. Results 371 patients with suspected choledocholithiasis underwent LC with IOI. CBD stones or obstructing sludge was identified in 107 patients (29%), with sensitivity of 96.2% and specificity of 98.5%. 100 patients, median age 59, went on to have LCBDE as indicated by intraoperative imaging. 76% were performed as emergency cases and conversion to open rate was 2%. There were no mortalities. Bile leak and retained stones occurred in 4% and 3% respectively. 7/100 patients required re-intervention, with re-look laparoscopy (n = 4) and ERCP (n = 3). Median length of stay was 1.5 and 3 days for elective and emergency cases respectively, and 30 readmission rate was 8%. Discussion and conclusion Traditionally patients presenting with suspicion of choledocholithiasis undergo preoperative MRCP/EUS and/or ERCP prior to eventual LC. We propose an alternative, more streamlined, pathway of treatment without requiring preoperative cholangiography, applicable to both elective and emergency patients. Laparoscopic common bile duct exploration is a safe and effective treatment for bile duct stones. Intraoperative cholangiography is sensitive and specific in identification of bile duct stones. Bile duct exploration can be safely performed on the basis on intraoperative imaging alone. Intraoperative imaging provides sufficient information for real time decision making.
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Affiliation(s)
- Timothy Platt
- General Surgery, South Devon NHS Foundation Trust, United Kingdom
| | - Kristy Smith
- Core Surgical Trainee, Norfolk and Norwich University Hospitals NHS Foundation Trust, United Kingdom
| | - Martha Nixon
- StR General Surgery, Plymouth Hospitals NHS Trust, United Kingdom
| | - Surajit Sinha
- Locum Consultant Upper GI Surgery, South Devon NHS Foundation Trust, United Kingdom
| | - Gandrapu Srinivas
- Consultant Upper GI Surgeon, South Devon NHS Foundation Trust, United Kingdom
| | - Stuart Andrews
- Consultant Upper GI Surgeon, South Devon NHS Foundation Trust, United Kingdom
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Cholecystectomy after endoscopic retrograde cholangiopancreatography - effect of time on treatment outcomes. GASTROENTEROLOGY REVIEW 2018; 13:251-257. [PMID: 30302173 PMCID: PMC6173079 DOI: 10.5114/pg.2018.78292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/12/2018] [Indexed: 11/23/2022]
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The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis. Ann Surg 2018. [DOI: 10.1097/sla.0000000000002731] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Daniel C, Pereira J, Prudente C, Constantino J, Sá M, Casimiro C. Laparoscopic choledochoscopy with Ambu ® aScope 3 ™ in the treatment of coledocholithiasis: a series of cases. J Surg Case Rep 2018; 2018:rjy046. [PMID: 29977501 PMCID: PMC6007370 DOI: 10.1093/jscr/rjy046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 01/05/2023] Open
Abstract
The progresses made in minimally invasive surgery, make it not only possible to perform isolated cholecystectomy, but also to provide a totally laparoscopic treatment of common bile duct lithiasis. In this approach, the use of choledochoscopy is indispensable for diagnostic and therapeutic success. This study describes the use of a disposable endoscope for choledochoscopy in the laparoscopic treatment of choledocholithiasis. We have analyzed the use of the Ambu® aScope 3™ disposable endoscope, normally used for bronchoscopy, in nine consecutive patients needing choledochoscopy in our Hospital. The patient average age was 78 years. Total clearance of the bile duct was obtained in seven patients. Bile duct vacuity was not obtained in two patients, but this is not attributed to equipment failure. There was one case of hemoperitoneum not related to equipment usage. This device is easy to use and looks promising for choledochoscopy in laparoscopic treatment of coledocholithiasis.
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Affiliation(s)
- Carlos Daniel
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
| | - Jorge Pereira
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
| | - César Prudente
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
| | - Júlio Constantino
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
| | - Milena Sá
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
| | - Carlos Casimiro
- General Surgery Department, Hospital S. Teotónio, 3500 Viseu, Portugal
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Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: Analysis of Practice Patterns of Intermountain HealthCare. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Passi M, Inamdar S, Hersch D, Dowling O, Sejpal DV, Trindade AJ. Inpatient Choledocholithiasis Requiring ERCP and Cholecystectomy: Outcomes of a Combined Single Inpatient Procedure Versus Separate-Session Procedures. J Gastrointest Surg 2018; 22:451-459. [PMID: 28971298 DOI: 10.1007/s11605-017-3588-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/13/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Separate-session endoscopic retrograde cholangiography (ERCP) and laparoscopic cholecystectomy (LC) is the usual method for management of inpatient choledocholithiasis. Our goal was to compare single operative-session LC and ERCP to a multi-session approach for both the same hospitalization and within 30 days after; there is limited data comparing the three groups. METHODS A retrospective review on inpatients with choledocholithiasis that underwent ERCP and LC was performed. Single operative-session ERCP + LC (SOS group) and separate hospitalization ERCP + LC (DH group) were compared against the control cohort: separate-session ERCP + LC performed during the same hospitalization (SH group). RESULTS Among the 214 cases, 37 (17%) had LC + ERCP performed under a single operative session (SOS), 130 (60.7%) cases had LC + ERCP performed in separate operative sessions during the same hospitalization (SH), and 47 (22%) cases had LC + ERCP performed in different hospitalizations, within 30 days (DH). There was no statistically significant difference in efficacy or adverse events. The SOS group had a statistically significant mean shorter length of hospital stay as compared to the SH and DH groups (5.46 vs 7.15 vs 9.38; p = 0.05 and 0.02). There was a statistically significant reduction in the total cost of care in the SOS group versus the SH group ($59,221 vs $75, 808; p = 0.007). CONCLUSION The SOS approach is safe, efficacious, and cost-efficient when compared to separate operative sessions. This approach can be considered in situations where it is preferable for the patient to undergo a single session of anesthesia, without compromising technical success and safety.
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Affiliation(s)
- Monica Passi
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Sumant Inamdar
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - David Hersch
- Hofstra Northwell School of Medicine, Northwell Health System, Department of Anesthesia, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Oonagh Dowling
- Hofstra Northwell School of Medicine, Northwell Health System, Department of Anesthesia, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Divyesh V Sejpal
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Arvind J Trindade
- Hofstra Northwell School of Medicine, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
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Mohseni S, Ivarsson J, Ahl R, Dogan S, Saar S, Reinsoo A, Sepp T, Isand KG, Garder E, Kaur I, Ruus H, Talving P. Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach. Eur J Trauma Emerg Surg 2018; 45:337-342. [PMID: 29417182 PMCID: PMC6450829 DOI: 10.1007/s00068-018-0921-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/02/2018] [Indexed: 01/17/2023]
Abstract
Introduction The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons. Methods Retrospective analysis of all consecutive patients subjected to LC + IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (± SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile). Results During the 29-month study, a total of 201 consecutive LC + IO-ERCPs were performed. The mean age of patients was 55 ± 19 years and 67% were female. The mean intervention time was 105 ± 44 min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3) days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged. Conclusion Simultaneous LC + IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.
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Affiliation(s)
- Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.
| | - John Ivarsson
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Rebecka Ahl
- Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden.,Department of Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Sinan Dogan
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Sten Saar
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Arvo Reinsoo
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Teesi Sepp
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Karl-Gunnar Isand
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Edvard Garder
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Ilmar Kaur
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Heiti Ruus
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
| | - Peep Talving
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Center, 13412, Tallin, Estonia
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Comparison of one stage laparoscopic cholecystectomy combined with intra-operative endoscopic sphincterotomy versus two-stage pre-operative endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the management of pre-operatively diagnosed patients with common bile duct stones: a meta-analysis. Surg Endosc 2017; 32:770-778. [PMID: 28733744 DOI: 10.1007/s00464-017-5739-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) for symptomatic gallstone disease is one of the most common surgical procedures. Concomitant common bile duct (CBD) stones are detected with an incidence of 4-20% and the ideal management is still controversial. The frequent practice is to perform endoscopic sphincterotomy pre-operatively (POES) followed by LC, to allow subsequent laparoscopic or open exploration if POES fails. However, POES has shown different drawbacks such as need for two hospital admissions, need of two anesthesia inductions, higher rate of pancreatitis, and longer hospital stay. Hence, an intra-operative endoscopic sphincerotomy (IOES) has been proposed. OBJECTIVE To compare the 1 stage laparoscopic cholecystectomy (LC) combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis. SEARCH STRATEGY The search terms bile duct stones/calculi, ERCP, endoscopic sphincterotomy, laparoendoscopic rendezvous (LERV), and laparoscopic ductal clearance/choledochotomy/exploration were used. A comprehensive hand-based search of reference lists of published articles and review articles was performed to ensure inclusion of all possible studies and exclude duplicates. SELECTION CRITERIA RCTs comparing 1 stage LC combined with IOES versus 2-stage POES followed by LC for the management of pre-operatively known cholecystocholedocholithiasis in adults. DATA COLLECTION & ANALYSIS Three reviewers assessed trial quality and extracted the data. Data were entered in revman version 5.3. The trials were grouped according to the outcome measure assessed such as success rate of CBD stone clearance, incidence of pancreatitis, overall morbidity, and length of hospital stay. MAIN RESULTS A total of 629 patients in 5 RCTs met the inclusion criteria. The success rate of CBD clearance (IOES = 93%, POES = 92%) was the same in both groups (OR 1.34; 95% CI 0.45-0.97; p = 0.60). Findings showed that IOES was associated with less pancreatitis (0.6%) than POES (4.4%) (OR 0.19; 95% CI 0.06-0.67; p = 0.01; I 2 = 43%). The incidence of overall morbidity was lower in the IOES group (6%) than the POES group (11%) (OR 0.54; 95% CI 0.31-0.96; p = 0.03; I 2 = 20%). The mean days of hospital stay for IOES group (M = 3.52, SD = 1.434, N = 5) was significantly less than the POES group (M = 6.10, SD = 2.074, N = 5), t(8) = 2.29, p <= 0.051. CONCLUSION IOES is at par with two-stage POES in terms of CBD clearance, with less incidence of post-operative pancreatitis, overall morbidity, and less hospital stay.
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38
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Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, Young T. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017; 66:765-782. [PMID: 28122906 DOI: 10.1136/gutjnl-2016-312317] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
Common bile duct stones (CBDS) are estimated to be present in 10-20% of individuals with symptomatic gallstones. They can result in a number of health problems, including pain, jaundice, infection and acute pancreatitis. A variety of imaging modalities can be employed to identify the condition, while management of confirmed cases of CBDS may involve endoscopic retrograde cholangiopancreatography, surgery and radiological methods of stone extraction. Clinicians are therefore confronted with a number of potentially valid options to diagnose and treat individuals with suspected CBDS. The British Society of Gastroenterology first published a guideline on the management of CBDS in 2008. Since then a number of developments in management have occurred along with further systematic reviews of the available evidence. The following recommendations reflect these changes and provide updated guidance to healthcare professionals who are involved in the care of adult patients with suspected or proven CBDS. It is not a protocol and the recommendations contained within should not replace individual clinical judgement.
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Affiliation(s)
- Earl Williams
- Bournemouth Digestive Diseases Centre, Royal Bournemouth and Christchurch NHS Hospital Trust, Bournemouth, UK
| | - Ian Beckingham
- HPB Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ghassan El Sayed
- Bournemouth Digestive Diseases Centre, Royal Bournemouth and Christchurch NHS Hospital Trust, Bournemouth, UK
| | - Kurinchi Gurusamy
- Department of Surgery, University College London Medical School, London, UK
| | - Richard Sturgess
- Aintree Digestive Diseases Unit, Aintree University Hospital Liverpool, Liverpool, UK
| | - George Webster
- Department of Hepatopancreatobiliary Medicine, University College Hospital, London, UK
| | - Tudor Young
- Department of Radiology, The Princess of Wales Hospital, Bridgend, UK
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Hua J, Meng H, Yao L, Gong J, Xu B, Yang T, Sun W, Wang Y, Mao Y, Zhang T, Zhou B, Song Z. Five hundred consecutive laparoscopic common bile duct explorations: 5-year experience at a single institution. Surg Endosc 2016; 31:3581-3589. [PMID: 28039642 DOI: 10.1007/s00464-016-5388-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) has gained wide popularity in the treatment of choledocholithiasis. Bile leakage remains a major cause of postoperative morbidity. The aim of this study was to report 5-year results of 500 LCBDEs and identify risk factors associated with bile leakage. METHODS Five hundred consecutive LCBDEs performed in one institution from September 2011 to June 2016 were reviewed. Patients' clinical data were retrospectively collected and analyzed. Univariable and multivariable analysis of bile leakage was performed by logistic regression. RESULTS We found stones (n = 388) or bile sludge (n = 71) in 459 patients (92%) on exploration, leaving 41 patients (8%) without stones. Operative time was 128 min in the first 250 LCBDEs, and this decreased to 103 min in the second 250 LCBDEs (P = 0.0004). Four hundred and eight (82%) procedures were completed with primary closure after choledochotomy; the rate of primary closure increased significantly in the second 250 patients compared with the first (88 vs 76%; P = 0.0005), whereas T-tube placement (2 vs 6%; P = 0.0225) and transcystic approach (7 vs 12%; P = 0.0464) decreased, respectively. Stone clearance was successful in 495 patients (99%). Overall morbidity was 5%, and bile leakage occurred in 17 patients (3.4%). Two patients died from bile leakage. The median follow-up was 24 months with stone recurrence occurred in two patients and bile duct stricture in one patient. Univariable analysis identified diameter of the common bile duct (CBD), stone clearance, and T-tube insertion as risk factors related to bile leakage. Multivariable analysis taking these three factors into account identified non-dilated CBD (risk ratio (RR) = 9.87; P = 0.007) and failure in stone clearance (RR = 11.88; P = 0.024) as significant risk factors. CONCLUSIONS Bile leakage following LCBDE is associated with diameter of the CBD and stone clearance. LCBDE would be safer in proficient laparoscopic surgeons with a careful selection of patients.
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Affiliation(s)
- Jie Hua
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Hongbo Meng
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Le Yao
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Jian Gong
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Bin Xu
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Tingsong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Yuxiang Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Yukan Mao
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Ti Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Bo Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China
| | - Zhenshun Song
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, China.
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Zheng C, Huang Y, Xie E, Xie D, Peng Y, Wang X. Laparoscopic common bile duct exploration: a safe and definitive treatment for elderly patients. Surg Endosc 2016; 31:2541-2547. [PMID: 28008469 DOI: 10.1007/s00464-016-5257-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Common bile duct (CBD) stone is one of the most common diseases among elderly people. In recent decades, there are numerous studies regarding the safety and efficacy of laparoscopic common bile duct exploration (LCBDE). Elderly patients are often regarded as high-risk patients because they are more likely to present with age-specific deterioration of organ function and coexisting chronic diseases, which may reduce their tolerance of laparoscopic surgery. Although laparoscopic surgery for choledocholithiasis is now widely accepted as the treatment for CBD stone, its appropriateness for the treatment of elderly patients or those with coexisting high-risk patients has not been well established. Therefore, the objective of this paper is to analyze the safety and efficacy of LCBDE in elderly patients. METHODS Between January 2012 and November 2015, 376 patients underwent LCBDE in our center. Based on their ages, they were divided into two groups, and a retrospective study was performed. By making comparisons between younger group who were younger than 70 years (n = 253) and elderly group who were 70 years old or older (n = 123), the demographics, clinical characteristics, laboratory data, operative parameters and outcomes were analyzed. RESULTS Before operation, elderly patients had more coexisting chronic diseases and risk factors, such as arterial hypertension, heart diseases, pulmonary diseases and previous abdominal surgery (P < 0.05). In both groups, LCBDE was equally successful with a high clearance rate (100 % in elderly patients vs. 98.8 % in younger group, P = 0.554). Besides, the operating time, intraoperative blood loss, postoperative hospital stay, total costs and overall complication showed no significant difference between two groups (P > 0.05). There was no major bile duct injury or death in either group. CONCLUSION Although elderly patients are frequently confronted with coexisting disorders, LCBDE can be considered as a safe and effective technique in choledocholithiasis treatment for elderly patients.
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Affiliation(s)
- Chufa Zheng
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Yaokui Huang
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - E Xie
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Dejin Xie
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Yunheng Peng
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China
| | - Xiaozhong Wang
- Department of General Surgery, the Affiliated Shantou Hospital of Sun Yat-sen University, Guangdong, 515000, China.
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Xia HT, Liang B, Liu Y, Yang T, Zeng JP, Dong JH. Ultrathin choledochoscope improves outcomes in the treatment of gallstones and suspected choledocholithiasis. Expert Rev Gastroenterol Hepatol 2016; 10:1409-1413. [PMID: 27796141 DOI: 10.1080/17474124.2016.1250623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND We aimed to compare laparoscopic cholecystectomy (LC) and simultaneous laparoscopic transcystic common bile duct exploration (LTCBDE) using an ultrathin choledochoscope with LC followed by endoscopic retrograde cholangiopancreatography (ERC) and endoscopic sphincterotomy (ES) when indicated. METHODS We retrospectively reviewed the records of patients seen between 2004 and 2014 and treated with LC+LTCBDE or LC for gallstones and suspected choledocholithiasis. Postoperative complications and surgical outcomes were compared using t-test, Mann-Whitney U test, or chi-square test. RESULTS 115 patients underwent successful LC+LTCBDE and 112 LC; follow-up data was available for 103 and 106 patients, respectively. Seventeen patients (16.5%) in the LC+LTCBDE group and 10 (28.6%) in the LC+ERC+ES group developed complications (P = 0.114). The LC+LTCBDE group had a significantly higher rate of satisfactory biliary function outcomes than the LC+ERC+ES group (98.1% vs. 85.7%, respectively) (P = 0.017). CONCLUSIONS Single-step LC+LTCBDE using an ultrathin choledochoscope may provide better outcomes in patients with gallstones and suspected choledocholithiasis.
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Affiliation(s)
- Hong-Tian Xia
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
| | - Bin Liang
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
| | - Yang Liu
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
| | - Tao Yang
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
| | - Jian-Ping Zeng
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
| | - Jia-Hong Dong
- a Hospital and Institute of Hepatobiliary Surgery , Chinese PLA General Hospital, Chinese PLA Medical School , Beijing , China
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Hosseini SV, Ayoub A, Rezaianzadeh A, Bananzadeh AM, Ghahramani L, Rahimikazerooni S, Khazraei H. A survey on concomitant common bile duct stone and symptomatic gallstone and clinical values in Shiraz, Southern Iran. Adv Biomed Res 2016; 5:147. [PMID: 27656616 PMCID: PMC5025909 DOI: 10.4103/2277-9175.187402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/07/2016] [Indexed: 01/11/2023] Open
Abstract
Background: Common bile duct stone (CBDS) as a result of gallstone is one of the gastrointestinal disorders. In this study, the incidence of CBDS and symptomatic gallstone in Shiraz were investigated, and their management suggested. Materials and Methods: This is a retrospective study that enrolled among 560 patients. The incidence of gallstone together with CBDS was evaluated using an ultrasonography studyand clinical data in the period between March 2014 and 2014 in Shiraz. Comparison between data was done using Student’s t-test or Chi-square test. Results: Of these patients, 18.6% were male, and 81.4% were female with a mean age of 47.67 ± 0.74 years. The concomitant rate of gallstone and CBDS was 8.6%. 6.8% of patients with concomitant of gallstone and CBDS showed symptoms while 1.8% had not been diagnosed before the operation. The mean of serum alkaline phosphatase level in patients with the only gallstone was 255.80 IU/L and patients with concomitant gallstone, and CBDS was 580.88 IU/L with a significant difference between two groups (P < 0.001). Furthermore, liver function tests (aspartate aminotransferase, alanine transaminase) showed a significant difference between two groups of patients (P < 0.01, P < 0.001). Conclusions: Clinical variables such as tenderness, fever, and Morphy sign were more severein patients with concomitant gallstone and CBDS. The concomitant rate of gallstone and CBDS in our society is less that Western countries and asymptomatic patients showed fewer ratios than other countries. We think the approach for asymptomatic CBDS patients with gallstone can be affected by our results.
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Affiliation(s)
- Seyed Vahid Hosseini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbass Ayoub
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Research Center for Health Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Leila Ghahramani
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Khazraei
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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A meta-analysis of single-stage versus two-stage management for concomitant gallstones and common bile duct stones. Clin Res Hepatol Gastroenterol 2015; 39:584-93. [PMID: 25936687 DOI: 10.1016/j.clinre.2015.02.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/22/2015] [Accepted: 02/05/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To conduct a randomized controlled trial (RCT) meta-analysis to evaluate the safety and effectiveness of single-stage [laparoscopic cholecystectomy (LC)+laparoscopic common bile duct exploration (LCBDE)] vs. two-stage management [preoperative endoscopic retrograde cholangiopancreatography (ERCP)+LC] for concomitant gallstones and common bile duct stones. METHODS RCTs that met the inclusion criteria for data extraction were identified from electronic databases (PubMed, Embase, Science Citation Index, and the Cochrane Library) up to August 2014. The relevant congressional proceedings were also searched. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, length of hospital stay, total operative time, and hospitalization charges. The outcomes were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using RevMan 5.2. RESULTS Eight RCTs, which included 1130 patients, were identified for analysis in our study. The meta-analysis revealed that the common bile duct stone clearance rate in the single-stage group was higher (OR=1.56, 95% CI: 1.05 to 2.33, P=0.03). The lengths of hospital stay (MD=-1.02, 95% CI: -1.99 to -0.04, P=0.04) and total operative times (MD=-16.78, 95% CI: -27.55 to -6.01, P=0.002) were also shorter in the single-stage group. There was no statistically significant difference between the two groups regarding postoperative morbidity (OR=1.12, 95% CI: 0.79 to 1.59, P=0.52), mortality (OR=0.29, 95% CI: 0.06 to 1.41, P=0.13) and conversion to other procedures (OR=0.82, 95% CI: 0.37 to 1.82, P=0.62). CONCLUSION Single- and two-stage management for cholecysto-choledocholithiasis had similar mortality and complication rates; however, the single-stage strategy was better in terms of stone clearance, hospital stay and total operative time.
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Aawsaj Y, Light D, Horgan L. Laparoscopic common bile duct exploration: 15-year experience in a district general hospital. Surg Endosc 2015; 30:2563-6. [PMID: 26307600 DOI: 10.1007/s00464-015-4523-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/17/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The treatment of common bile duct (CBD) stones remains controversial with debate between endoscopic cholangiopancreatography (ERCP) and CBD exploration. A recent meta-analysis has shown no significant difference between these approaches; however, there is a trend in the literature to favour a single-stage procedure in the form of laparoscopic CBD exploration. We report our experience over a 15-year period. METHODS All cases of CBD exploration were identified from 2000 to 2015 and analysed retrospectively from a large NHS Foundation Trust in Northumbria. There were no exclusions. The mean clinical follow-up was 6 months (range 3-36 months). RESULTS A total of 296 patients were included who underwent laparoscopic CBD exploration: 203 were female and 93 were male. The mean age was 60 years (range 16-84 years). A total of 231 procedures were performed electively and 65 as an emergency. Ten procedures were successfully performed as day cases. Eleven procedures were converted to an open procedure due to adhesions or a difficult dissection (4 %). Sixty-three procedures were performed with a transcystic approach with a mean post-op stay of 2 days (range 0-7). A total of 233 procedures were performed with a choledocotomy with a mean post-op stay of 6 days (range 3-14 days). Stone clearance was successful in 255 patients (86 %). Three patients died over the study period. Two were for medical complications and one for abdominal sepsis. Three patients returned to theatre for early post-operative bleeding (1 %). Sixteen patients had persistent bile leaks following a choledocotomy (6.8 %). No patients had a bile leak following transcystic exploration. Fourteen patients were followed up following failed stone removal. Nine had a successful ERCP, three had no stone seen on MRCP, and one patient required re-operation following a failed ERCP. CONCLUSIONS Laparoscopic bile duct exploration can be performed successfully in both the emergency and elective settings. Day-case surgery is feasible in selected patients. A transcystic approach should be favoured where possible.
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Affiliation(s)
- Yousif Aawsaj
- Northumbria NHS Trust, Rake Lane, North Shields, NE29 8NH, UK
| | - Duncan Light
- Northumbria NHS Trust, Rake Lane, North Shields, NE29 8NH, UK.
| | - Liam Horgan
- Northumbria NHS Trust, Rake Lane, North Shields, NE29 8NH, UK
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