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Wu PH, Yu MW, Chuang SC, Wang SN, Kuo KK, Chang WT, Chuang SH, Su WL, Huang JW, Chen LA. Comparison of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy for elderly patients with common bile duct stones and gallbladder stones. J Gastrointest Surg 2024; 28:719-724. [PMID: 38503593 DOI: 10.1016/j.gassur.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/02/2024] [Accepted: 02/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Common bile duct (CBD) stones commonly occur in cholecystectomy cases. The management options include laparoscopic CBD exploration (LCBDE) or endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). Although ERCP is fully developed, it has complications, and LCBDE is a proven alternative. This study aimed to evaluate the safety and efficacy of these treatments in elderly individuals aged ≥70 years. METHODS A retrospective study between January 2015 and July 2022 included 160 elderly patients (aged ≥70 years) diagnosed with cholelithiasis and choledocholithiasis. The patients were divided into 1-stage (LCBDE [n = 80]) or 2-stage (ERCP followed by LC [n = 80]) treatment groups. Data collected encompassed comorbidities, symptoms, bile duct clearance, postoperative complications, and long-term outcomes for systematic analysis. RESULTS This study analyzed 160 patients treated for CBD stones, comparing 1-stage and 2-stage groups. The 1-stage group had more female patients than the 2-stage group (57.5% vs 37.5%, respectively). The 1-stage group had a mean age of 80.55 ± 7.00 years, which was higher than the mean age in the 2-stage group. American Society of Anesthesiologists classification, Charlson Comorbidity Index, and laboratory findings were similar. Pancreatitis and cholangitis occurred after ERCP in the 2-stage group. Stone clearance rates (92.35% [1-stage group] vs 95.00% [2-stage group]) and biliary leakage incidence (7.5% [1-stage group] vs 3.0% [2-stage group]) were similar, as were postoperative complications and long-term recurrence rates (13.0% [1-stage group] vs 12.5% [2-stage group]). CONCLUSION Our research indicates that both the combination of LCBDE and LC and the sequence of ERCP followed by LC are equally efficient and secure when treating CBD stones in elderly patients. Consequently, the 1-stage procedure may be considered the preferred treatment approach for this demographic.
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Affiliation(s)
- Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Min-Wei Yu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Wen-Tsan Chang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Wen-Lung Su
- Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan
| | - Jian-Wei Huang
- Department of Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung City, Taiwan
| | - Ling-An Chen
- Department of Surgery, Ministry of Health and Welfare Pingtung Hospital, Pingtung County, Taiwan
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Luo T, Huang Y, Wang S, Yang T, Gong J, Zhou B, Song Z, Meng H, Xu B. Laparoscopic common bile duct exploration with primary closure is preferred for selected elderly individuals with choledocholithiasis. Ann Gastroenterol Surg 2023; 7:772-783. [PMID: 37663961 PMCID: PMC10472361 DOI: 10.1002/ags3.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background Laparoscopic common bile duct exploration with primary closure (LCBDE-PC) exhibits more benefits than other surgeries for patients with choledocholithiasis. It remains unclear whether it is feasible for and beneficial to elderly individuals. This study aimed to clarify and stratify elderly patients who would benefit from LCBDE-PC. Methods A retrospective study of 1240 patients with choledocholithiasis who underwent laparoscopic procedures between 2011 and 2019 was conducted. Patients were divided into the young group (<65 years old, n = 708) and the elderly group (≥65 years old, n = 532). Perioperative outcomes were compared between the two groups. Results Laparoscopic common bile duct exploration with primary closure was successfully performed in 90.20% of the elderly and 94.20% of the young. No significant differences were observed between the two groups regarding reoperation, postoperative bile leakage, residual stones, drainage removal, and postoperative mortality. Compared with the young, the elderly had longer postoperative hospital stay (p = 0.035) and delayed postoperative eating time (p = 0.036) in the matched cohort. Independent risk factors for failed LCBDE-PC were preoperative pancreatitis (p = 0.018), year of the surgeon's experience (p = 0.008), preoperative C-reactive protein level (p = 0.034), preoperative total bilirubin (p = 0.021), impacted common bile duct (CBD) stones (p = 0.006), blood loss (p = 0.001), and edema of the CBD (p = 0.001). A novel nomogram for predicting failed LCBDE-PC in elderly individuals exhibited a sufficient discriminative ability according to the estimated area under the curve (AUC) of 0.869 (95% CI: 0.817-0.921, p < 0.01). Conclusion Laparoscopic common bile duct exploration with primary closure is safe, feasible, and effective for elderly individuals with choledocholithiasis. Elderly patients with a high risk of failed LCBDE-PC should be cautious of undergoing LCBDE-PC.
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Affiliation(s)
- Tingyi Luo
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Yonggang Huang
- Department of General Surgery, Kunshan Hospital of Traditional Chinese MedicineKunshan Affiliated Hospital of Nanjing University of Chinese MedicineSuzhou, JiangsuChina
| | - Shilin Wang
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Tingsong Yang
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Jian Gong
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Bo Zhou
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Zhenshun Song
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Hongbo Meng
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Bin Xu
- Department of General Surgery, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zhang L, Li L, Yao J, Chu F, Zhang Y, Wu H. Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterol 2022; 22:509. [PMID: 36494797 DOI: 10.1186/s12876-022-02601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The best intervention approach for residual choledocholithiasis after choledocholithotomy T-tube drainage remains controversial, especially during the period of indwelling T tube and the formation of a sinus. The purpose of the study was to estimate the effects of two therapeutic modalities, namely endoscopic retrograde cholangiopancreatography (ERCP) and choledochfiberscope via the T-tube sinus tract (CDS) on residual choledocholithiasis after choledocholithotomy T-tube drainage. METHODS A total of 112 patients with residual choledocholithiasis after choledochotomy were included in the study, 50 of which underwent ERCP and 62 patients experienced choledochoscopy via the T-tube sinus tract. The primary outcome measures included the success rate of remove biliary stones, T-tube drainage time, and the average length of hospital stay. The secondary objective was to consider incidence of adverse events including cholangitis, bile leakage, T-tube migration, pancreatitis, bleeding and perforation. After hospital discharge, patients were followed up for two years and the recurrence of choledocholithiasis was recorded. RESULTS There was no significant difference in the success rate of stone removal between the two groups. Compared to CDS group, T-tube drainage time and the average length of hospital stay was significantly shorter in the ERCP group. The incidence of complications (cholangitis and bile leakage) in the ERCP group was lower than that in the CDS group, but there was no statistically significant difference. When the T-tube sinus tract is not maturation, ERCP was the more appropriate endoscopic intervention to remove residual choledocholithiasis, particularly complicated with cholangitis at this time period. CONCLUSIONS ERCP is a safe and effective endoscopic intervention to remove residual choledocholithiasis after choledocholithotomy T-tube Drainage without the condition of T-tube sinus tract restriction.
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Abstract
Choledocholithiasis is a chronic common disease. The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis. Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%. The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors. We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.
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Affiliation(s)
- Yao Wu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China
| | - Chen Jing Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China
| | - Shun Fu Xu
- Sir Run Run Hospital, Nanjing Medical University, Nanjing, 211100, China.,Jiangsu Province Hospital, Nanjing Medical University, Nanjing, 210029, China
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Gomez D, Cabrera LF, Villarreal R, Pedraza M, Pulido J, Sebastián S, Urrutia A, Mendoza A, Zundel N. Laparoscopic Common Bile Duct Exploration With Primary Closure After Failed Endoscopic Retrograde Cholangiopancreatography Without Intraoperative Cholangiography: A Case Series from a Referral Center in Bogota, Colombia. J Laparoendosc Adv Surg Tech A 2020; 30:267-272. [PMID: 32053025 DOI: 10.1089/lap.2019.0547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Despite the effectiveness of laparoscopic common bile duct (CBD) surgery, no case series details the use and advantages of laparoscopic CBD exploration (LCBDE) without use of intraoperative cholangiography (IOC) in endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we present a case series regarding our success with LCBDE in managing CBD stones (CBDSs) using laparoscopic technique without IOC. Materials and Methods: We performed a descriptive retrospective observational study. Patients with CBDSs, alone or along with gallbladder stones, were treated through LCBDE with primary CBD closure after failed ERCP. Results: All patients underwent LCBDE with choledocotomy and primary duct closure. Patients with gallbladder stones underwent laparoscopic cholecystectomy (78%). All procedures were successful, and no conversions occurred. Surgery duration averaged 106 minutes. Intraoperative bleeding averaged 15 cc, and no mortalities occurred. No patients required additional surgery or intensive care unit admission. Hospitalization duration averaged 5 days. Conclusions: Therefore, a laparoscopic approach with primary CBD closure after failed ERCP for complex CBDSs is safe and effective.
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Affiliation(s)
- Daniel Gomez
- Department of Advanced Laparoscopic Surgery, Military University, Bogota, Colombia.,Department of General Surgery, Centro Policlínico Olaya Bogota, Bogota, Colombia
| | - Luis F Cabrera
- Department of General Surgery, Cobos Medical Center, El Bosque University, Bogota, Colombia.,Department of Medicine, Universidad Pedagógica y Tecnológica de Tunja, Tunja, Colombia.,Department of General Surgery, Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Ricardo Villarreal
- Department of General Surgery, Cobos Medical Center, El Bosque University, Bogota, Colombia.,Department of Gastrointestinal Surgery, Cobos Medical Center, Universidad El Bosque, Bogota, Colombia.,Department of Medicine, El Bosque University, Bogota, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, Cobos Medical Center, El Bosque University, Bogota, Colombia.,Department of Medicine, El Bosque University, Bogota, Colombia
| | - Jean Pulido
- Department of General Surgery, Cobos Medical Center, El Bosque University, Bogota, Colombia.,Department of Medicine, El Bosque University, Bogota, Colombia.,Medical Illustrator, Bogota, Colombia
| | - Sánchez Sebastián
- Department of General Surgery, Cobos Medical Center, El Bosque University, Bogota, Colombia.,Department of Medicine, El Bosque University, Bogota, Colombia
| | - Andrés Urrutia
- Department of Medicine, Universidad Pedagógica y Tecnológica de Tunja, Tunja, Colombia
| | - Andrés Mendoza
- Department of General Surgery, Centro Policlínico Olaya Bogota, Bogota, Colombia.,Department of Medicine, El Bosque University, Bogota, Colombia
| | - Natan Zundel
- Department of General Surgery, Fundación Santa Fe de Bogota, Bogota, Colombia.,FIU Herbert Wertheim College of Medicine, Miami, Florida.,Minimally Invasive and Bariatric Surgery, FSFB, Bogota, Colombia
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Zhu J, Tu S, Yang Z, Fu X, Li Y, Xiao W. Laparoscopic common bile duct exploration for elderly patients with choledocholithiasis: a systematic review and meta-analysis. Surg Endosc 2020; 34:1522-33. [PMID: 32016517 DOI: 10.1007/s00464-020-07394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) has been becoming more and more popular in patients with symptomatic choledocholithiasis. However, the safety and effectiveness of LCBDE in elderly patients with choledocholithiasis is still uncertain. This meta-analysis is aimed to appraise the safety and feasibility of LCBDE for elderly patients with choledocholithiasis. MATERIALS AND METHODS Studies comparing elderly patients and younger patients who underwent LCBDE for common bile duct stone were reviewed and collected from the PubMed, Medline, EMBASE, and Cochrane Library. Primary outcomes were stone clearance rate, overall complication rate, and mortality rate. Secondary outcomes were operative time, conversion rate, pulmonary complication, bile leakage, reoperation, residual stone rate, and recurrent stone rate. RESULTS Nine studies, including two prospective studies and seven retrospective studies, met the inclusion criteria. There were 2004 patients in this meta-analysis, including 693 elderly patients and 1311 younger patients. There was no statistically significant difference between elderly patients and younger patients regarding stone clearance rate (OR 0.73; 95% CI 0.42-1.26; p = 0.25), overall complication rate (OR 1.31; 95% CI 0.94-1.82; p = 0.12), and mortality rate (OR 2.80; 95% CI 0.82-9.53; p = 0.10). Similarly, the operative time, conversion rate, bile leakage, reoperation, residual stone rate, and recurrent stone rate showed no significant difference between two groups (p > 0.05). While elderly patients showed high risk for pulmonary complication (OR 4.41; 95% CI 1.78-10.93; p = 0.001) compared with younger patients. CONCLUSION Although there is associated with higher pulmonary complication, LCBDE is still considered as a safe and effective treatment for elderly patients with choledocholithiasis.
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Park SY, Hong TH, Lee SK, Park IY, Kim TH, Kim SG. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: a multicenter study. J Hepatobiliary Pancreat Sci 2019; 26:578-582. [DOI: 10.1002/jhbp.675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sun Young Park
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
| | - Tae Ho Hong
- Department of Hepatobiliary and Pancreas Surgery Seoul St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Seoul Korea
| | - Sang Kuon Lee
- Department of General Surgery Daejeon St. Mary’s Hospital College of Medicine The Catholic University of Korea Daejeon Korea
| | - Il Young Park
- Department of General Surgery Bucheon St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea Bucheon Korea
| | - Tae Hyeon Kim
- Division of Gastroenterology Department of Internal Medicine Wonkwang University Medical School and Hospital Iksan Korea
| | - Sung Geun Kim
- Department of General Surgery Yeouido St. Mary’s HospitalCollege of MedicineThe Catholic University of Korea 63‐ro 10, Yeongdeungpo‐gu Seoul07345Korea
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García-Cano J, Domper F. The best approach to treat concomitant gallstones and common bile duct stones. Is ERCP still needed? Rev Esp Enferm Dig 2019; 111:173-175. [PMID: 30799627 DOI: 10.17235/reed.2019.6226/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors analyze what should be the best approach to treat patients who had concomitant gallstones and common bile duct stones (CBDS). Laparoscopic common bile duct exploration (LCBDE) appears to be an atractive way to cure all kind of biliary stones in a single procedure. However, when scientific literature is reviewed most patients continue to need from ERCP for CBDS removal. ERCP can be performed before, after or during the same LC procedure. Patients with LCBDE had less pancreatitis rate because the Papilla of Vater is not manipulated but more bile leaks. Large CBDS continue to need, in general, from ERCP techniques.
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Affiliation(s)
| | - Francisco Domper
- Department of Digestive Diseases, Hospital General Universitario
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [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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