1
|
Gerosa M, Guttadauro A, Stillittano DF, Sassun R, Sileo A, Vignati B, Di Fratta E, Maggioni D, Mari G. Single stage laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography for cholecysto-choledocholithiasis. Lesson learnt from the COVID-19 pandemic. Front Surg 2024; 11:1398854. [PMID: 38957742 PMCID: PMC11217298 DOI: 10.3389/fsurg.2024.1398854] [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: 03/10/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Choledocholithiasis, a common complication of gallstone disease, poses significant risks including cholangitis and pancreatitis. Various treatment approaches exist, including single-stage and two-stage techniques, with recent literature suggesting advantages of the single-stage approach in terms of outcomes and cost-effectiveness. This study evaluates the feasibility, efficacy, and safety of single-stage laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC + iERCP) compared to the previously adopted two-stage approach. Methods A retrospective analysis was conducted on patients undergoing single-stage LC + iERCP for cholecysto-choledocholithiasis during the COVID-19 pandemic (2020-2022). Data on demographics, preoperative assessments, intraoperative parameters, and postoperative outcomes were collected and compared with an historical control group undergoing the two-stage approach (LC + preopERCP). Hospitalization costs were also compared between the two groups. Results A total of 190 patients were included, with 105 undergoing single-stage LC + iERCP. The single-stage approach demonstrated successful completion without cystic duct cannulation, with no conversions to open surgery. Operative time was comparable to the two-stage approach, while hospital stay, and costs were significantly lower in the single-stage group. Complication rates were similar between the groups. Conclusions Single-stage LC + iERCP appears to be a feasible, effective, and safe approach for treating cholecysto-choledocholithiasis, offering potential benefits in terms of reduced hospital stay, OR occupation time, and costs compared to the two-stage approach. Integration of this approach into clinical practice warrants consideration, unless there are logistical challenges that cannot be overcome or lack of endoscopic expertise also for treating challenging urgent cases.
Collapse
Affiliation(s)
- Martino Gerosa
- Laparoscopic and Oncological General Surgery Department, Desio Hospital, ASST Brianza, Desio, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Richard Sassun
- General Surgery Residency, University of Milan, Milan, Italy
| | - Annaclara Sileo
- General Surgery Residency, University of Milan, Milan, Italy
| | - Barbara Vignati
- General Surgery Residency, University of Milan, Milan, Italy
| | - Emanuele Di Fratta
- Laparoscopic and Oncological General Surgery Department, Desio Hospital, ASST Brianza, Desio, Italy
| | - Dario Maggioni
- Laparoscopic and Oncological General Surgery Department, Desio Hospital, ASST Brianza, Desio, Italy
| | - Giulio Mari
- Laparoscopic and Oncological General Surgery Department, Desio Hospital, ASST Brianza, Desio, Italy
| |
Collapse
|
2
|
Obaitan I, Mohamed MFH, Beran A, Rosenheck M, Obomanu ET, Berzin TM, Ramai D, Wehbe H, Aziz M, Mahendraker N, Al-Haddad M, Easler JJ, Fogel EL. Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis. Dig Dis Sci 2024; 69:1880-1888. [PMID: 38555329 DOI: 10.1007/s10620-024-08374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients. METHODS We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel-Haenszel method within a random-effect model. RESULTS Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56-4.31, p ≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups. CONCLUSIONS Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.
Collapse
Affiliation(s)
- Itegbemie Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Mouhand F H Mohamed
- Department of Internal Medicine, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Rosenheck
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elvis T Obomanu
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Hisham Wehbe
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad Aziz
- Division of Gastroenterology, Bon Secours Mercy Health, Toledo, OH, USA
| | - Neetu Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
3
|
Zhou J, Chen Y, Yu S, Wang H, Wang Y, Chen Q. Comparison of 1-stage and 2-stage Managements for Common Bile Duct Stones and Gallstones (CBDS): A Retrospective Study. J Clin Gastroenterol 2024:00004836-990000000-00290. [PMID: 38648497 DOI: 10.1097/mcg.0000000000002009] [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: 11/30/2023] [Accepted: 03/17/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy, safety, and surgical outcomes of 2-stage management, namely preoperative endoscopic retrograde cholangiopancreatography (ERCP) + laparoscopic cholecystectomy (ERCP+LC) or LC + postoperative ERCP (LC+ERCP), as well as 1-stage management, LC + laparoscopic common bile duct exploration (LCBDE) for treating patients with gallstones and common bile duct stones (CBDS). METHODS This retrospective study analyzed the data of 180 patients with common bile duct stones (CBDS) who were admitted to the Department of General Surgery at Tongji Hospital, Tongji University, between January 2019 and June 2021. The study included 3 groups: ERCP+LC (group 1), LC+ERCP (group 2), and LC+LCBDE (group 3), each consisting of 60 patients. Clinical metrics of the patients were collected and compared among the groups. RESULTS Group 3 had the shortest operation duration and hospital stay compared with group 1 and group 2. In addition, group 3 had the lowest long-term postoperative complications, particularly the recurrence rate of CBDS. The total cost was also the lowest in group 3. Furthermore, patients in group 3 had the lowest postoperative amylase levels. All patients in the study achieved successful stone clearance. There were no significant differences in the conversion to other procedures rate, postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and mortality among the three groups (P > 0.05). CONCLUSIONS Both 1-stage management and 2-stage management are effective treatments for CBDS. The LC+LCBDE management is a safe treatment option, offering shorter hospital stays and operation duration, lower costs, and fewer complications.
Collapse
Affiliation(s)
| | - Ye Chen
- Department of Gastroenterology, Tongji Institute of Digestive Disease, Tongji Hospital of Tongji University, Tongji University School of Medicine, Shanghai, China
| | - Songlin Yu
- General Surgery, Tongji Hospital of Tongji University
| | - Hui Wang
- General Surgery, Tongji Hospital of Tongji University
| | - Yufeng Wang
- General Surgery, Tongji Hospital of Tongji University
| | - Quanning Chen
- General Surgery, Tongji Hospital of Tongji University
| |
Collapse
|
4
|
Pouplin J, Maulat C, Yubero G, Shourick J, Cuellar E, Culetto A, Barange K, Buscail L, Carrere N, Peron JM, Suc B, Bournet B, Boulard P, Muscari F. Curative surgical treatment of common bile duct stones: Retrospective cohort study. World J Surg 2024; 48:692-700. [PMID: 38348553 DOI: 10.1002/wjs.12093] [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: 10/27/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND In the event of symptomatic common bile duct (CBD) stones with dilated CBD, one possible curative treatment option is stone extraction through choledocotomy associated with cholecystectomy. Endoscopic treatment is only reserved for residual stones at 6 weeks. The aim of this study was to evaluate the results from laparoscopic curative surgical treatment of CBD stones with dilated CBD. METHODS This is a retrospective single-centered cohort study. All consecutive patients admitted for laparoscopic cholecystectomy with evidence of CBD stones with dilated CBD from January 2010 to December 2020 at our center were included. Success was defined by CBD clearance at 6 weeks. Need for additional procedures, such as endoscopic sphincterotomy, immediate, and end-of-procedure morbi-mortality as well as factors associated with procedure failure, were also studied. RESULTS A total of 246 patients who received curative treatment were included in the study. The success rate for the curative treatment was 93.1% (229 patients). Immediate postoperative morbidity was 24.4% with a 5.3% reintervention rate. Immediate and 6-week postoperative mortality rates were zero and 0.4%, respectively. The mean length of stay was 11.3 days. Factors associated with procedure failure appeared to be the occurrence of an early postoperative complication and the need for readmission during the period between surgery and drain removal. CONCLUSION This study indicates that laparoscopic curative surgical treatment for symptomatic CBD stones may be performed with acceptable results without routine need for additional procedures.
Collapse
Affiliation(s)
- Julien Pouplin
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Charlotte Maulat
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Gabriel Yubero
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Jason Shourick
- Epidemiology Department, Toulouse University Hospital, Toulouse, France
| | - Emmanuel Cuellar
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Adrian Culetto
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Karl Barange
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Louis Buscail
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Nicolas Carrere
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Jean-Marie Peron
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Bertrand Suc
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Barbara Bournet
- Gastroenterology Department, Toulouse University Hospital, Toulouse, France
| | - Paul Boulard
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| | - Fabrice Muscari
- Digestive Surgery and Transplantation Department, Toulouse University Hospital, Toulouse, France
| |
Collapse
|
5
|
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.
Collapse
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.)
| |
Collapse
|
6
|
Hedström J, Nilsson J, Andersson B. Cholecystectomy and ERCP in pregnancy: a nationwide register-based study. Int J Surg 2024; 110:324-331. [PMID: 37800571 PMCID: PMC10793794 DOI: 10.1097/js9.0000000000000812] [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: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. SUMMARY BACKGROUND DATA Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. METHODS Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. RESULTS A total of 21 328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. CONCLUSION Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.
Collapse
Affiliation(s)
| | - Johan Nilsson
- Department of Cardiothoracic Surgery, Skåne University Hospital
- Department of Translational Medicine, Lund University, Lund, Sweden
| | | |
Collapse
|
7
|
Zouki J, Sidhom D, Bindon R, Sidhu T, Chan E, Lyon M. Choledocholithiasis: A Review of Management and Outcomes in a Regional Setting. Cureus 2023; 15:e50223. [PMID: 38192960 PMCID: PMC10773468 DOI: 10.7759/cureus.50223] [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] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Background Choledocholithiasis is a common surgical presentation with an incidence of 8% to 16% in symptomatic cholelithiasis. Treatment often requires a multi-stage approach via endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC), which can prolong the length of stay (LoS) and expose patients to unnecessary risks. A single-stage procedure, such as LC with common bile duct exploration (CBDE), is a safe and effective option that may decrease LoS. This study compares patient outcomes and management in a regional center and aims to identify factors that predict the presence of confirmed choledocholithiasis. Methods A retrospective cross-sectional analysis was performed on all patients admitted to Toowoomba Hospital for management of diagnosed or suspected choledocholithiasis from January 2021 to March 2023. Patient demographics, ERCP findings, and operative data were collated. Results A total of 195 patients were identified, including 136 patients undergoing multi-stage management, 34 patients who had an ERCP alone, and 25 patients who underwent single-stage management. Single-stage procedures had an 80% success rate with an average LoS of 3.6 days. Multi-stage procedures had an average LoS of 8.1 days and an ERCP success rate of 93%. Complication rates between ERCP (11.7%) and LC with CBDE (9.7%) were comparable. Time to index ERCP and serum bilirubin level were found to be significantly lower in those with positive index ERCP findings compared to those without. Conclusion Single-stage procedures are a safe way to manage choledocholithiasis and are associated with a reduced LoS when compared to multi-stage management, with comparable efficacy and morbidity rates.
Collapse
Affiliation(s)
- Jason Zouki
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| | - David Sidhom
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| | | | | | - Erick Chan
- General Surgery, Gold Coast Hospital and Health Service, Gold Coast, AUS
| | - Matthew Lyon
- General Surgery, Toowoomba Hospital, Toowoomba, AUS
| |
Collapse
|
8
|
Parkinson M, Poirier J, Belmore E, Kelly L. Rendezvous procedure, a simultaneous endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy for choledocholithiasis, in a rural surgical program in Northwest Ontario. CANADIAN JOURNAL OF RURAL MEDICINE 2023; 28:190-194. [PMID: 37861603 DOI: 10.4103/cjrm.cjrm_8_23] [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] [Indexed: 10/21/2023]
Abstract
Introduction Northwest Ontario has a high prevalence of cholelithiasis, at 1.6 times the provincial norm. There is a concomitant 14% rate of choledocholithiasis. Accessing surgical services in the region often requires extensive travel by air. Choledocholithiasis management is typically with a 2-staged approach, an endoscopic retrograde cholangiopancreatography (ERCP) followed several days or weeks later by laparoscopic cholecystectomy (LC). Regional surgeons were concerned about the patient burden of travel and the loss to follow-up inherent in scheduling two independent procedures at separate hospital admissions. They adopted a 1-stage management, called the rendezvous procedure, which describes the simultaneous performance of an ERCP and LC. Methods We accessed Sioux Lookout Meno Ya Win Health Centre hospital data for all patients receiving an ERCP and LC between 1 June 2019 and 1 December 2022. We documented patient demographics, operative outcomes, length of stay and transfer to other facilities. Results There were 29 rendezvous procedures performed, with successful cannulation of the ampulla of Vater in 27 (93%) cases and stone removal in 23 (79%), with a complication rate of 7%. The operating time averaged 136 min, and two patients required transfer to a tertiary care centre and four were stented locally and required a return trip to Sioux Lookout for repeat ERCP and successful stone removal. The average length of stay was 2.1 ± 1.3 days. Patients who could not access a rendezvous procedure averaged 46.1 ± 78.1 days between procedures. Conclusion Managing choledocholithiasis with a 1-stage approach was safe and effective and reduced patient travel, time to definitive care and hospital admissions.
Collapse
Affiliation(s)
- Matt Parkinson
- Division of Clinical Sciences, NOSM University; Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Jenna Poirier
- Northern Ontario School of Medicine University, Sioux Lookout Local Education Group, Sioux Lookout, Ontario, Canada
| | - Erin Belmore
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout; Northern Ontario School of Medicine University, Sioux Lookout Local Education Group, Sioux Lookout, Ontario, Canada
| |
Collapse
|
9
|
Qi S, Xu J, Yan C, He Y, Chen Y. Early versus delayed laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography: A meta-analysis. Medicine (Baltimore) 2023; 102:e34884. [PMID: 37682128 PMCID: PMC10489342 DOI: 10.1097/md.0000000000034884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSES Patients with cholecysto- and choledocholithiasis usually undergo endoscopic retrograde cholangiopancreatography (ERCP)/-endoscopic sphincterotomy followed by laparoscopic cholecystectomy (LC). However, differences in the timing of LC after the ERCP may alter the post-operative outcomes. The aim of this study was to compare the effect of early (≤3 days) or delayed LC (>3 days) following ERCP on the post-operative outcomes. METHODS A comprehensive search of the 3 databases PubMed, EMBASE and the Cochrane Library was performed. Articles related to LC at different time-points after ERCP were retrieved. Dichotomous and continuous outcomes were analyzed by risk ratio (RR) and mean difference, and RevMan was used to analyze each group. RESULTS A total of 7 studies, including 5 randomized controlled studies and 2 retrospective studies, involved a total of 711 patients. There were 332 patients in early LC group and 379 in delayed LC group. The conversion rate was lower in the early LC group compared to the delayed LC group (RR 0.38, 95% confident interval 0.19 to 0.74, P = .005, I2 = 0%). Early LC resulted in a shorter operation time (RR -6.2, 95% CI -27.2 to -5.2, P = .004, I2 = 97%) and fewer complications (RR 0.48, 95% CI 0.29 to 0.79, P = .004, I2 = 17%). Subgroup analysis found that there were no significant differences in the conversion rate (RR 0.61, 95% CI 0.25 to 1.45, P = .26, I2 = 0%) or complications between the early LC group and the delayed group who underwent LC after 1 month. CONCLUSION Early LC after ERCP is the preferred treatment for patients with concurrent cholecysto- and choledocholithiasis due to improved clinical outcomes as compared to those who undergo delayed LC.
Collapse
Affiliation(s)
- Sheng Qi
- General Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Jie Xu
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Chao Yan
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Yanan He
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| | - Yao Chen
- Hepatobiliary Surgery, The People’s Hospital of Jiangyou, Sichuan Province, China
| |
Collapse
|
10
|
Fujita N, Yasuda I, Endo I, Isayama H, Iwashita T, Ueki T, Uemura K, Umezawa A, Katanuma A, Katayose Y, Suzuki Y, Shoda J, Tsuyuguchi T, Wakai T, Inui K, Unno M, Takeyama Y, Itoi T, Koike K, Mochida S. Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol 2023; 58:801-833. [PMID: 37452855 PMCID: PMC10423145 DOI: 10.1007/s00535-023-02014-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The Japanese Society of Gastroenterology first published evidence-based clinical practice guidelines for cholelithiasis in 2010, followed by a revision in 2016. Currently, the revised third edition was published to reflect recent evidence on the diagnosis, treatment, and prognosis of cholelithiasis conforming to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Following this revision, the present English version of the guidelines was updated and published herein. The clinical questions (CQ) in the previous version were reviewed and rearranged into three newly divided categories: background questions (BQ) dealing with basic background knowledge, CQ, and future research questions (FRQ), which refer to issues that require further accumulation of evidence. Finally, 52 questions (29 BQs, 19 CQs, and 4 FRQs) were adopted to cover the epidemiology, pathogenesis, diagnosis, treatment, complications, and prognosis. Based on a literature search using MEDLINE, Cochrane Library, and Igaku Chuo Zasshi databases for the period between 1983 and August 2019, along with a manual search of new information reported over the past 5 years, the level of evidence was evaluated for each CQ. The strengths of recommendations were determined using the Delphi method by the committee members considering the body of evidence, including benefits and harms, patient preference, and cost-benefit balance. A comprehensive flowchart was prepared for the diagnosis and treatment of gallbladder stones, common bile duct stones, and intrahepatic stones, respectively. The current revised guidelines are expected to be of great assistance to gastroenterologists and general physicians in making decisions on contemporary clinical management for cholelithiasis patients.
Collapse
Affiliation(s)
- Naotaka Fujita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Miyagi Medical Check-up Plaza, 1-6-9 Oroshi-machi, Wakabayashi-ku, Sendai, Miyagi, 984-0015, Japan.
| | - Ichiro Yasuda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Itaru Endo
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroyuki Isayama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takuji Iwashita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiharu Ueki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kenichiro Uemura
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akiko Umezawa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akio Katanuma
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yu Katayose
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yutaka Suzuki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Junichi Shoda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshio Tsuyuguchi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshifumi Wakai
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuo Inui
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Michiaki Unno
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yoshifumi Takeyama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takao Itoi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Satoshi Mochida
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| |
Collapse
|
11
|
Zhao C, Xu Z, Hu W, Ge C, Zhang Z, Dai Z, Zhang S, Tang N, Wang W, Gu J, Chen C, He S. A Retrospective Study on the Three-Port Technique of Laparoscopic Common Bile Duct Exploration for the Management of Cholelithiasis and Choledocholithiasis. Int J Gen Med 2023; 16:3435-3445. [PMID: 37587978 PMCID: PMC10426449 DOI: 10.2147/ijgm.s415752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC) with laparoscopic common bile duct exploration (LCBDE) is convenient in treating cholelithiasis and choledocholithiasis due to its advantage of accelerated recovery. This retrospective study aimed to summarize the experience of cholelithiasis and choledocholithiasis treatment via three-port approach of LCBDE in Eastern China. Methods Patients diagnosed with cholelithiasis and choledocholithiasis between July 2019 and October 2021 were included. Patients who received LC+LCBDE+primary suturing of the common bile duct (CBD) via a three-port approach were assigned to the LCBDE-P group, and those who received LC+LCBDE+T-tube drainage of CBD comprised the LCBDE-T group. The measurement data were compared between the two groups. P-values <0.05 indicated statistical significance. Results A total of 88 patients were divided into two groups: LCBDE-P (n=50) and LCBDE-T (n=38). Multiple logistic regression analysis showed that LCBDE-P is associated with a shorter length of stay (OR=0.115, 95% CI: 0.040-0.329, P<0.001) and lower hospitalization costs (OR=0.120, 95% CI: 0.041-0.357, P<0.001). No significant differences between the two groups were detected in the operation time, intraoperative hemorrhage, clearance rate of CBD stones, postoperative liver function, and postoperative complications (P>0.05). Conclusion The three-port approach of LCBDE is a safe and feasible strategy for managing cholelithiasis and choledocholithiasis. Compared to LCBDE-T, LCBDE-P reduces the length of hospital stay and medical costs during hospitalization.
Collapse
Affiliation(s)
- Chunlong Zhao
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Zipeng Xu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Weidong Hu
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Chen Ge
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Zhengwei Zhang
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Zhengxing Dai
- Department of Interventional and Vascular Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Shuo Zhang
- Department of Hepatic-Biliary-Pancreatic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Neng Tang
- Department of Hepatic-Biliary-Pancreatic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Weiguo Wang
- Department of Interventional and Vascular Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Jiayu Gu
- Department of Interventional and Vascular Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
| | - Chaobo Chen
- Department of General Surgery, Xishan People’s Hospital of Wuxi City, Wuxi, People’s Republic of China
- Department of Hepatic-Biliary-Pancreatic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China
- Department of Immunology, Ophthalmology & ORL, Complutense University School of Medicine, Madrid, Spain
| | - Songbing He
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| |
Collapse
|
12
|
Parkinson M, Poirier J, Kelly L. Intervention en 1 étape pour la cholédocholithiase dans un service de chirurgie en milieu rural canadien. CMAJ 2023; 195:E962-E964. [PMID: 37487620 PMCID: PMC10365852 DOI: 10.1503/cmaj.221707-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Matt Parkinson
- Centre de santé Meno Ya Win de Sioux Lookout ( Parkinson, Kelly); Division des sciences cliniques (Parkinson), l'École de médecine du Nord de l'Ontario (EMNO); Groupe pour la formation locale de l'EMNO de Sioux Lookout (Poirier), Sioux Lookout, Ont
| | - Jenna Poirier
- Centre de santé Meno Ya Win de Sioux Lookout ( Parkinson, Kelly); Division des sciences cliniques (Parkinson), l'École de médecine du Nord de l'Ontario (EMNO); Groupe pour la formation locale de l'EMNO de Sioux Lookout (Poirier), Sioux Lookout, Ont
| | - Len Kelly
- Centre de santé Meno Ya Win de Sioux Lookout ( Parkinson, Kelly); Division des sciences cliniques (Parkinson), l'École de médecine du Nord de l'Ontario (EMNO); Groupe pour la formation locale de l'EMNO de Sioux Lookout (Poirier), Sioux Lookout, Ont.
| |
Collapse
|
13
|
Wang Y, Murphy D, Li S, Chen B, Peluso H, Sondhi V, Abougergi MS. Thirty-Day Readmission Among Patients With Uncomplicated Choledocholithiasis: A Nationwide Readmission Database Analysis. J Clin Gastroenterol 2023; 57:624-630. [PMID: 35648885 DOI: 10.1097/mcg.0000000000001724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM We aimed to determine the rate of 30-day hospital readmissions of uncomplicated choledocholithiasis and its impact on mortality and health care use in the United States. METHODS Nonelective admissions for adults with uncomplicated choledocholithiasis were selected from the Nationwide Readmission Database 2016-2018. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were reasons for readmission, readmission mortality rate, procedures, and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. RESULTS The 30-day rate of readmission was 9.3%. Biliary and pancreatic disorders and postprocedural complications accounted for 36.6% and 10.3% of readmission, respectively. The mortality rate among patients readmitted to the hospital was higher than that for index admissions (2.0% vs. 0.4%, P <0.01). Readmitted patients were less likely to receive endoscopic retrograde cholangiopancreatography (61% vs. 69%, P <0.01) and laparoscopic cholecystectomy (12.5% vs. 26%, P <0.01) during the index admissions. A total of 42,150 hospital days was associated with readmission, and the total health care in-hospital economic burden was $112 million (in costs) and $470 million (in charges). Independent predictors of readmission were male sex, Medicare (compared with private) insurance, higher Elixhauser Comorbidity Index score, no endoscopic retrograde cholangiopancreatography or laparoscopic cholecystectomy, postprocedural complications of the digestive system, hemodynamic or respiratory support, urban hospitals, and lower hospital volume of uncomplicated choledocholithiasis. CONCLUSIONS The uncomplicated choledocholithiasis 30-day readmission rate is 9.3%. Readmission was associated with higher mortality, morbidity, and resource use. Multiple independent predictors of readmission were identified.
Collapse
Affiliation(s)
- Yichen Wang
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Dermot Murphy
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Si Li
- Department of Internal Medicine, Wright Center for Graduate Medical Education, Scranton, PA
| | - Bing Chen
- Department of Medicine, Mount Sinai Morningside and West, New York City, NY
| | - Heather Peluso
- Department of Surgery, Prisma Health Upstate, Greenville
| | - Vikram Sondhi
- Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA
| | - Marwan S Abougergi
- Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia
- Catalyst Medical Consulting, Simpsonville, SC
| |
Collapse
|
14
|
Crichton J, Cox S, Tong C, Leow P, Field X, Welsh F. Observation versus intervention for incidental common bile duct stones at intraoperative cholangiogram: a systematic review. ANZ J Surg 2023; 93:1839-1846. [PMID: 37381094 DOI: 10.1111/ans.18581] [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: 05/07/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The natural history of incidental common bile duct stones (CBDS) is poorly understood. Current evidence is conflicting, with several studies suggesting the majority may pass spontaneously. Despite this, guidelines recommend routine removal even if asymptomatic. This study aimed to systematically review the outcomes of expectant management for CBDS detected on operative cholangiography during cholecystectomy. METHODS MEDLINE, Embase and CINAHL databases were systematically searched. Participants were adult patients with CBDS identified by intraoperative cholangiography. Intervention was regarded as any perioperative effort to remove common bile duct stones, including endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic and open bile duct exploration. This was compared to observation. Outcomes of interest included rates of spontaneous stone passage, success of duct clearance and complications. Risk of bias was assessed using the ROBINS-I tool. RESULTS Eight studies were included. All studies were non-randomized, heterogeneous and at serious risk of bias. In patients observed after a positive IOC, 20.9% went on to have symptomatic retained stones. In patients directed to ERCP for positive IOC, persistent CBDS were found in 50.6%. Spontaneous passage was not associated with stone size. Meta-analysis is dominated by the results from one large database, which recommends intervention for incidental stones, despite low rates of persistent stones seen at postoperative ERCP. CONCLUSIONS Further evidence is required before a definitive recommendation on observation can be made. There is some evidence that asymptomatic stones may be safely observed. In clinical scenarios where the risks of biliary intervention are considered high, a conservative strategy could be more widely considered.
Collapse
Affiliation(s)
- J Crichton
- Department of General Surgery, Te Whatu Ora Waitaha Canterbury, Christchurch Hospital, Christchurch, New Zealand
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - S Cox
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - C Tong
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - P Leow
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - X Field
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - F Welsh
- Department of General Surgery, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| |
Collapse
|
15
|
Hu K, Zhang H, Shu M, Wang X. Efficacy of post-first-line agents for advanced gastrointestinal stromal tumors following imatinib failure: A network meta-analysis. Cancer Med 2023. [PMID: 37084005 DOI: 10.1002/cam4.5912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Imatinib is the standard first-line treatment for advanced gastrointestinal stromal tumors (GISTs); however, most patients eventually develop imatinib resistance, leading to considerable clinical challenges. Few direct comparisons have been made between different post-first-line therapies on clinical efficacy in advanced GIST following imatinib failure. METHODS Databases including PubMed, Embase, Scopus, Google Scholars, and Cochrane Library from inception to February 2023 were retrieved for randomized controlled trials evaluating the clinical efficacy of different post-first-line agents for advanced GIST following imatinib failure. Network and conventional meta-analysis were carried out using Stata/MP 16.0. RESULTS Ripretinib showed significant improvement in progression-free survival (PFS) rates from the 2nd to the 12th month compared to placebo, while there was virtually no evidence that the rest active agents had a significant benefit at the 12th month. Masitinib, ripretinib, sunitinib, regorafenib, and pimitespib exhibited significantly longer median PFS than placebo, and pairwise comparisons indicated there were no significant differences among masitinib, ripretinib, and sunitinib. These post-first-line agents decreased the risk of disease progression or death by 65% (HR = 0.35, 95% CI: 0.26-0.47) compared to placebo. Ripretinib and sunitinib came into effect earlier and exhibited more consistent overall survival (OS) rate improvements than masitinib and pimitespib, while pairwise comparisons revealed no significant differences in these four active agents concerning the improvement in OS rate. These post-first-line agents decreased the risk of death by 39% (HR = 0.61, 95% CI: 0.44-0.83) over placebo for advanced GIST following imatinib failure. CONCLUSION The active agents in our analysis as post-first-line therapies are able to provide superior clinical efficacy, with improved PFS rate and OS rate at certain time points, as well as absolute values of PFS and OS for advanced GIST. Ripretinib might be the optimal recommendation as a post-first-line treatment for advanced GIST following imatinib failure.
Collapse
Affiliation(s)
- Kehan Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
- Centre for Inflammatory Bowel Disease, Institution of Inflammation and Immunity, West China Hospital, Sichuan University, Chengdu, China
- Lab of Inflammatory Bowel Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Hu Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
- Centre for Inflammatory Bowel Disease, Institution of Inflammation and Immunity, West China Hospital, Sichuan University, Chengdu, China
- Lab of Inflammatory Bowel Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Mingrong Shu
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyue Wang
- Department of Graduate Medical Education, West China School of Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
16
|
Parkinson M, Poirier J, Kelly L. Rendezvous procedure for choledocholithiasis in a Canadian rural surgical service. CMAJ 2023; 195:E513-E514. [PMID: 37040991 PMCID: PMC10089630 DOI: 10.1503/cmaj.221707] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Affiliation(s)
- Matt Parkinson
- Sioux Lookout Meno Ya Win Health Centre (Parkinson, Kelly); Division of Clinical Sciences (Parkinson), Northern Ontario School of Medicine (NOSM) University; Sioux Lookout-NOSM Local Education Group (Poirier), Sioux Lookout, Ont
| | - Jenna Poirier
- Sioux Lookout Meno Ya Win Health Centre (Parkinson, Kelly); Division of Clinical Sciences (Parkinson), Northern Ontario School of Medicine (NOSM) University; Sioux Lookout-NOSM Local Education Group (Poirier), Sioux Lookout, Ont
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre (Parkinson, Kelly); Division of Clinical Sciences (Parkinson), Northern Ontario School of Medicine (NOSM) University; Sioux Lookout-NOSM Local Education Group (Poirier), Sioux Lookout, Ont.
| |
Collapse
|
17
|
Hu L, Shi X, Wang A. Comparison of different time intervals between laparoscopic cholecystectomy to endoscopic retrograde cholangiopancreatography for patients with cholecystolithiasis complicated by choledocholithiasis. Front Surg 2023; 9:1110242. [PMID: 37007627 PMCID: PMC10050469 DOI: 10.3389/fsurg.2022.1110242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/29/2022] [Indexed: 03/17/2023] Open
Abstract
BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is a common strategy for treatment of patients with gallstones with co-existing stones in the common bile duct (CBD). We conducted this study to compare the effect of different time intervals between ERCP and LC.MethodsA total of 214 patients who underwent elective LC after ERCP for gallstones and CBD stones between January 2015 and May 2021 were retrospectively reviewed. We compared the hospital stay, operation time, perioperative morbidity, and conversion rate to open cholecystectomy, according to the interval between ERCP and ERCP and LC, namely, one day, 2–3 days, and 4 days or more. A generalized linear model was used to analyze the differences among the groups for outcomes.ResultsThere were a total of 214 patients with 52, 80, and 82 patients in group 1, group 2, and group 3 respectively. These groups did not differ significantly in terms of major complications or conversion to open surgery (p = 0.503 and p = 0.358, respectively). The generalized linear model showed that operation times in group 1 and group 2 were similar (odds ratio (OR) 0.144, 95% confidence interval (CI) 12.597, 8.511, p = 0.704), while operation time was significantly longer in group 3 than in group 1 (OR 4.005, 95% CI, 0.217, 20.837, p = 0.045). Post-cholecystectomy hospital stay was similar among the three groups, while post-ERCP hospital stay was significantly longer in group 3 compared with group 1.ConclusionWe recommend that LC be performed within three days after ERCP to reduce operating time and hospital stay.
Collapse
Affiliation(s)
- Lingbo Hu
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
| | - Xingpeng Shi
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
| | - Aidong Wang
- Department of Hepatopancreatobiliary Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Zhejiang, China
- Department of Hepatopancreatobiliary Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Zhejiang, China
- Correspondence: Aidong Wang
| |
Collapse
|
18
|
Zhu J, Wang G, Xie B, Jiang Z, Xiao W, Li Y. Minimally invasive management of concomitant gallstones and common bile duct stones: an updated network meta-analysis of randomized controlled trials. Surg Endosc 2023; 37:1683-1693. [PMID: 36278995 DOI: 10.1007/s00464-022-09723-8] [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: 06/26/2022] [Accepted: 10/11/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND To update a 2018 meta-analysis on the comparative efficacy and safety of four surgical techniques in patients with concomitant gallstones and common bile duct (CBD) stones. METHODS Randomized controlled trials (RCTs) comparing laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE), LC plus preoperative endoscopic retrograde cholangiopancreatography (PreERCP), LC plus intraoperative ERCP (IntraERCP), and LC plus postoperative ERCP (PostERCP) were included. Primary and secondary outcomes were compared using odds ratio, weighted mean difference, and 95% confidence intervals. RESULTS Twenty-five RCTs involved 3145 patients were included. Of these, 1188 (37.8%) underwent LC + PreERCP, 1183 (37.6%) LC + LCBDE, 689 (21.9%) LC + IntraERCP, and 85 (2.7%) LC + PostERCP. This analysis demonstrated that LC plus IntraERCP was the most likely approach to achieve technical success and reduce morbidity. No significant differences were observed between the four treatments concerning major morbidity, mortality, and operative time. LC plus LCBDE was effective for increasing biliary leak and conversion as well as decreasing postoperative hemorrhage and total costs. Additionally, LC plus PreERCP was associated with higher postoperative pancreatitis, while LC plus IntraERCP was associated with a shorter length of hospital stay. There was significant heterogeneity in operative time, hospital stay, and total costs (τ2 > 1). CONCLUSIONS This analysis provides evidence that LC plus IntraERCP appears to be the optimal strategy for patients with concomitant gallstones and CBD stones owing to its advantage in technical success and morbidity. LC plus LCBDE is associated with higher biliary leak and lower postoperative hemorrhage, whereas LC plus PreERCP is associated with higher postoperative pancreatitis.
Collapse
Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China
| | - Guiyan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China
| | - Bin Xie
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China
| | - Zhengying Jiang
- Department of Burn, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
| |
Collapse
|
19
|
Durán M, Silvestre J, Hernández J, Briceño J, Martínez-Isla A, Martínez-Cecilia D. Learning curve for performing laparoscopic common bile duct exploration in biliary surgery 2.0 era. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:374-382. [PMID: 35947065 DOI: 10.1002/jhbp.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/27/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent trials and metanalysis have demonstrated the favorable results of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) for the treatment of cholecysto-choledocholithiasis. The aim of this study was to evaluate the LC + LCBDE learning curve including transcystic and transductal approaches and its effect on the outcomes. METHODS We identified all unselected patients who underwent LC + LCBDE by a single surgeon between May 2017 and July 2021. Pre-, intra-, and postoperative data were analyzed using the cumulative sum (CUSUM) analysis to evaluate the learning curve. RESULTS A total of 110 patients were included. Total postoperative complications rate was 12.7%, including bile leakage in six (5.5%) patients. Mean length of hospital stay was 2.7 (1-14) days. No patient had conversion to open surgery. The CUSUM graph divided the learning curve into three distinct phases: (1) Learning (1-38), (2) Competence (39-61) and (3) Proficiency (62-110). There was a significant increase in the transcystic approach rate with each phase (44.7% vs 73.9% vs 98%; P < .001). A significant decrease in the operative time (150.9 vs 117.6 vs 99.9 min; P < .001) and complication rate (21.1% vs 21.7% vs 2%; P = .01) were observed across the three phases. CONCLUSION Our data suggest that the learning curve for complete competence in LC + LCBDE is approximately 60 cases, provided that proper training is available. The initial learning phase can be carried out safely and efficiently with acceptable results.
Collapse
Affiliation(s)
- Manuel Durán
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital, Cordoba, Spain
| | - José Silvestre
- Department of Hepatobiliary Surgery, Hospital Universitario de Toledo, Toledo, Spain
| | - Jara Hernández
- Department of Hepatobiliary Surgery, Hospital Universitario de Toledo, Toledo, Spain
| | - Javier Briceño
- Department of Hepatobiliary Surgery and Liver Transplantation, Reina Sofia University Hospital, Cordoba, Spain
| | - Alberto Martínez-Isla
- Department of Upper GI Surgery, Northwick Park Hospital & St Marks Hospitals, London, UK
| | - David Martínez-Cecilia
- Department of Hepatobiliary Surgery, Hospital Universitario de Toledo, Toledo, Spain.,Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitario La Princesa, Madrid, Spain
| |
Collapse
|
20
|
One-step laparoscopic cholecystectomy with common bile duct exploration and stone extraction versus two-step endoscopic retrograde cholangiography with stone extraction plus laparoscopic cholecystectomy for patients with common bile duct stones: a randomised feasibility and pilot clinical trial-the preGallStep trial. Pilot Feasibility Stud 2023; 9:21. [PMID: 36740708 PMCID: PMC9899655 DOI: 10.1186/s40814-023-01251-z] [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: 05/04/2022] [Accepted: 01/24/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiography (ERC) with stone extraction and papillotomy with subsequent laparoscopic cholecystectomy-the two-step approach-is the standard treatment of common bile duct stones in many countries. However, ERC is associated with a high risk of complications and more than half of patients require multiple ERCs. Meta-analyses of randomised clinical trials find no major differences of the two-step approach in comparison with laparoscopic cholecystectomy with intraoperative laparoscopic stone clearance-the one-step approach. Currently, there are insufficient data to ascertain superiority. METHODS The preGallstep trial is an investigator-initiated, multicentre randomised feasibility and pilot clinical trial with blinded outcome assessment. Eligible patients are patients with common bile duct stones (identified by magnetic resonance cholagiopancreatography), age 18 years or above with the possibility to perform both interventions within a reasonable time. We intent to randomise 150 participants allocated 1:1. The experimental intervention is the one-step approach. This consists of laparoscopic common bile duct exploration plus laparoscopic cholecystectomy. The control intervention is the two-step approach which consists of ERC plus sphincterotomy (first step) and subsequent laparoscopic cholecystectomy (second step). Feasibility outcomes include the proportion of eligible patients not wanting to participate, reasons for rejection to participate, difficulties during the informed consent procedure, difficulties with randomisation, difficulties with data management, difficulties with blinding patient charts and forms and difficulties with maintaining blinding for the outcome assessors. The primary pilot outcome is the proportion of participants with at least one postoperative complication according to the Clavien-Dindo score grade II and above until 90 days after randomisation. This outcome will be used for a future sample size calculation of a larger pragmatic trial. Further, a range of clinical explorative outcomes will be assessed. DISCUSSION As no sample size is estimated in this trial, there is a risk of wrongly assessing the effect on the patient-related outcome. The surgical procedures cannot be blinded. However, blinding will be employed in all other aspects of the trial, including the establishment of a blinded outcome adjudication committee with three independent assessors. Heterogeneity in screening, randomisation, diagnostics, treatment procedures, interventions and follow-up across trial sites may cause challenges in conducting a larger pragmatic trial. To monitor inter-site differences, we have implemented a central data monitoring scheme. TRIAL REGISTRATION ClinicalTrials.gov identification: NCT04801238 , Registered on 16 March 2021.
Collapse
|
21
|
De Silva HM, Howard T, Yong T, Hodgson R. Comparing Stone Recurrence Following Surgical Common Bile Duct Exploration or Endoscopic Stone Extraction for Patients with Common Bile Duct Stones. J Laparoendosc Adv Surg Tech A 2023; 33:389-396. [PMID: 36735566 DOI: 10.1089/lap.2022.0526] [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: 02/04/2023] Open
Abstract
Background: Laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are two methods of retrieving common bile duct (CBD) stones. Aspects of CBD stone management, such as sphincterotomy, have been implicated as risks for CBD stone recurrence although evidence is weak. The aim of this study was to compare stone recurrence following LCBDE and/or ERCP. Methods: Data were collected retrospectively for patients undergoing LCBDE and/or ERCP for CBD stones at a single center from 2008 to 2018. Primary outcome was stone recurrence (>6 months after duct clearance). Risk factors for recurrence were assessed using univariate and multivariate analyses. Results: A total of 445 patients underwent LCBDE-only, 79 patients underwent ERCP-only and 80 patients underwent LCBDE-ERCP. LCBDE-only patients were younger and preoperatively less morbid than ERCP-only patients. Although there was no significant difference for recurrence, there was a trend toward higher recurrence with ERCP-only compared with LCBDE-only and LCBDE-ERCP (5.1% versus 2.0% and 2.5%, P = .280). On univariate comparison, patients with a recurrence were significantly older, had a higher admission white cell count, higher number of ERCPs, increased transampullary stent use, and higher maximum CBD diameter. Total number of ERCP was the only independent predictor of stone recurrence (odds ratio 6.85 [2.55-18.42], P < .001) following multivariate regression. Conclusion: Management plan was not associated with stone recurrence. The total number of ERCP was the only independent predictor of recurrence. Within the limitations of case selection and bias toward LCBDE, this study suggests that limiting repeated ERCP may reduce CBD stone recurrence.
Collapse
Affiliation(s)
| | - Tess Howard
- Division of Surgery, Northern Health, Epping, Australia
| | - Tuck Yong
- Division of Surgery, Northern Health, Epping, Australia
| | - Russell Hodgson
- Division of Surgery, Northern Health, Epping, Australia.,Department of Surgery, University of Melbourne, Epping, Australia
| |
Collapse
|
22
|
T-Tube Drainage During Laparoscopic Common Bile Duct Exploration: a Safe and Valid Option in Selected Cases. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
23
|
Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterol 2022; 22:509. [PMID: 36494797 PMCID: PMC9733260 DOI: 10.1186/s12876-022-02601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
Collapse
|
24
|
Feng H, Wang N, Xie D, Yang Z, Zeng C, Lei G, Li H, Wang Y. Anteromedial Portal Technique, but Not Outside-in Technique, Is Superior to Standard Transtibial Technique in Knee Stability and Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis. Arthroscopy 2022; 39:1515-1525. [PMID: 36577618 DOI: 10.1016/j.arthro.2022.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the postoperative outcomes of 4 different femoral drilling techniques in anterior cruciate ligament reconstruction. METHODS Three databases were searched for randomized controlled trials comparing any 2 or more of the following femoral drilling techniques in anterior cruciate ligament reconstruction: standard transtibial (sTT), anteromedial portal (AMP), outside-in (OI), or modified transtibial (mTT) technique. A Bayesian network meta-analysis was performed to assess postoperative stability and functional recovery in terms of the side-to-side difference (measured by arthrometry), Lachman test, pivot-shift test, International Knee Documentation Committee subjective and objective scores, Lysholm score, and Tegner score. The Fisher exact probability test and χ2 test were used to compare the incidences of infection and graft rupture, respectively. RESULTS We included 20 randomized controlled trials involving 1,515 patients. The AMP technique showed a lower side-to-side difference (standardized mean difference, -0.33; 95% credible interval [CrI], -0.53 to -0.12), higher negative rate on the pivot-shift test (odds ratio, 2.19; 95% CrI, 1.38 to 3.44), and higher International Knee Documentation Committee objective score (odds ratio, 3.13; 95% CrI, 1.42 to 7.82) than the sTT technique. However, knee stability and functional outcomes did not differ significantly between the OI and sTT techniques. Safety outcomes of the mTT technique were unavailable. The incidence of graft rupture was 5.20% for the OI technique, 2.27% for the AMP technique, and 1.51% for the sTT technique. The OI technique had a significantly higher incidence of graft rupture than the sTT technique (χ2 = 4.421, P = .035). No significant difference in the incidence of infection was found between the sTT, AMP, and OI techniques (P = .281). CONCLUSIONS The AMP technique, but not the OI technique, was superior to the sTT technique in knee stability and functional recovery. The OI technique had a higher incidence of graft rupture than the sTT technique. There was no significant difference between the AMP and OI techniques or between the mTT technique and any other femoral drilling technique. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and II studies.
Collapse
Affiliation(s)
- Haoran Feng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Zidan Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
25
|
De Silva HM, Howard T, Bird D, Hodgson R. Outcomes following common bile duct exploration versus endoscopic stone extraction before, during and after laparoscopic cholecystectomy for patients with common bile duct stones. HPB (Oxford) 2022; 24:2125-2133. [PMID: 36130852 DOI: 10.1016/j.hpb.2022.08.014] [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: 03/02/2022] [Revised: 07/24/2022] [Accepted: 08/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography (ERCP) are two methods of retrieving common bile duct (CBD) stones. The best method for CBD stone removal is debatable. The aim of this study was to compare outcomes following LCBDE and/or ERCP, including laparoscopic cholecystectomy. METHODS Data were collected retrospectively for patients undergoing LCBDE and/or ERCP at a single centre from 2008 to 2018. Patients were grouped by intention-to-treat (single-stage LCBDE, pre-operative-, intra-operative-, or post-operative ERCP) and eventual plan (surgical or endoscopic). Outcomes included complication rates (minor Clavien-Dindo 1/2, major Clavien-Dindo 3/4, non-biliary complications) and mortality. RESULTS Of 671 patients, 578 patients received LCBDE and 93 patients received ERCP as primary care. Endoscopic clearance had significantly higher complications and mortality compared to surgical clearance. On an intention-to-treat basis LCBDE had the lowest minor-, major- and non-biliary complications, and mortality (5.2%, 6.1%, 2.9% and 0.5%, respectively), whilst pre-operative ERCP the worst (39.6%, 27.1%, 29.2% and 8.3%, respectively) (p=<0.001). LCBDE and postERCP had similar major complications and mortality. CONCLUSION Surgical clearance of CBD stones was potentially safer than endoscopic clearance. Pre-operative ERCP had the worst outcomes. LCBDE and postERCP are likely to have similar short-term patient outcomes.
Collapse
Affiliation(s)
| | - Tess Howard
- Division of Surgery, The Northern Hospital, Epping, Australia
| | - David Bird
- Division of Surgery, The Northern Hospital, Epping, Australia
| | - Russell Hodgson
- Division of Surgery, The Northern Hospital, Epping, Australia; Department of Surgery, University of Melbourne, Epping, Australia.
| |
Collapse
|
26
|
Lopez-Lopez V, Gil-Vazquez PJ, Ferreras D, Nassar AHM, Bansal VK, Topal B, Zhu JG, Chuang SH, Jorba R, Bekheit M, Martinez-Cecilia D, Parra-Membrives P, Sgourakis G, Mattila A, Bove A, Quaresima S, Barreras González JE, Sharma A, Ruiz JJ, Sánchez-Bueno F, Robles-Campos R, Martinez-Isla A. Multi-institutional expert update on the use of laparoscopic bile duct exploration in the management of choledocholithiasis: Lesson learned from 3950 procedures. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1283-1291. [PMID: 35122406 DOI: 10.1002/jhbp.1123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently there has been a growing interest in the laparoscopic management of common bile duct stones with gallbladder in situ (LBDE), which is favoring the expansion of this technique. Our study identified the standardization factors of LBDE and its implementation in the single-stage management of choledocholithiasis. METHODS A retrospective multi-institutional study among 17 centers with proven experience in LBDE was performed. A cross-sectional survey consisting of a semi-structured pretested questionnaire was distributed covering the main aspects on the use of LBDE in the management of choledocholithiasis. RESULTS A total of 3950 LBDEs were analyzed. The most frequent indication was jaundice (58.8%). LBDEs were performed after failed ERCP in 15.2%. The most common approach used was the transcystic (63.11%). The overall series failure rate of LBDE was 4% and the median rate for each center was 6% (IQR, 4.5-12.5). Median operative time ranged between 60-120 min (70.6%). Overall morbidity rate was 14.6%, with a postoperative bile leak and complications ≥3a rate of 4.5% and 2.5%, respectively. The operative time decreased with experience (P = .03) and length of hospital stay was longer in the presence of a biliary leak (P = .04). Current training of LBDE was defined as poor or very poor by 82.4%. CONCLUSION Based on this multicenter survey, LBDE is a safe and effective approach when performed by experienced teams. The generalization of LBDE will be based on developing training programs.
Collapse
Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pedro José Gil-Vazquez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ahmad H M Nassar
- University Hospital Monklands, Airdrie, UK
- University of Glasgow, Glasgow, UK
| | - Virinder K Bansal
- Departments of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Baki Topal
- Department of Visceral Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Jie-Gao Zhu
- Department of General Surgery, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Centre of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rosa Jorba
- Department of General and Digestive Surgery, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Mohamed Bekheit
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, UK
| | | | - Pablo Parra-Membrives
- Hepatobiliary and Pancreatic Surgery Unit, Valme University Hospital, Sevilla, Spain
| | - Georgios Sgourakis
- Departament of General Surgery, Royal Blackburn Hospital NHS Trust, Burnley, UK
| | - Anne Mattila
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Aldo Bove
- Department of Medicine, Dentistry and Biotechnology, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | | | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Speciality Hospital, Dehradun, India
| | - Juan Jose Ruiz
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | | |
Collapse
|
27
|
Thapar VB, Thapar PM, Goel R, Agarwalla R, Salvi PH, Nasta AM, Mahawar K, Karthik A, Lakshman A, Amit A, Rishabh A, Manas A, Anmol A, Varadaraj AK, Murtaza A, Temsula A, Reddy AD, Srinivas A, Rambabu B, Rajendra B, Sarfaraz B, Manish B, Lovenish B, Lal BB, Rajandeep B, Rajesh B, Sharath B, Somendra B, Akshay B, Sonali B, Bhavneet B, Jatin B, Siddhartha B, Rajesh B, Bisht SD, Arjun B, Pankaj B, Vijay B, Prashanta B, Chandra BR, Chitra C, Kanhaiyya C, Sakthivel C, Bitan C, Shamita C, Tamonas C, Madeswaran CVC, Shreya C, Aditya C, Sourav C, Supriya C, Pradeep C, H CA, Ashwani D, Usha D, Abhay D, Chitta D, Ram DG, kumar DJ, Arupabha D, Rupjyoti D, Kunal D, Ashish D, Sumanta D, Monika D, Nilesh D, Poornima DB, Sanjay D, Easwaramoorthy S, Nishith E, Reddy EV, Naima G, Amitabh G, Apoorv G, Deep G, Thakut G, Pankaj G, Achal G, Rajkumar G, Rahul G, Shalu G, Shardool G, Lokesh HM, Nisar H, Sarath H, Bhaskar H, Vikas H, Srikantaiah H, Hariharasaran I, Mohammad I, Chaidul I, Samsul I, Mohammed I, Amit J, Mohit J, Parakash J, Sumita J, Advait J, Nikita J, Samrat J, James J, Yashpaul J, Abhijit J, Praveen J, Rejana J, Pooja K, Prasad K, Anirudhan K, Vishakha K, Adityakalyan K, Manmohan K, Abhimanyu K, Mayank K, Rohan K, Jaspreet K, Hosni K, Archana K, Ajay K, Khandelwal RG, Subhash K, Shashi K, Elbert K, Rajesh K, Suhail K, Shashank K, Uttam K, Shyam K, Prakash KC, Jyotsna K, Anil K, Bhartendu K, Durgesh K, Jitendra K, Shashidhar K, Saurabh K, Kshitiz K, Puneet K, Ranjith K, Hampher K, Krishnaswamy L, Suchitra L, Kona L, Nishanth L, Pawan L, Samuel L, Alfred L, Manjusha L, Lancelot L, Sushil L, Temsutoshi L, MuniReddy M, Vijaykumar M, Sivakumar M, Deepak M, Singh MM, Prasad MBV, Kumar MN, Suman M, Parth M, Shresth M, Faiz M, Alok M, Noushif M, Sadananda M, Magan M, Diksha M, Senthil M, Prakash MG, Lalan M, Subhash M, Taher M, Tarun M, kushal M, Rajan M, Abhiram M, Erbaz M, Rajashekar M, Ramya M, Khalid M, Sheetal AM, Majid M, Dileep N, Nikhil N, Ramprasanna NN, Madhavi N, Anand N, Govind N, Kumar NB, Barun N, Darshan N, Manjunath N, Rohit N, Ashok NO, Prabha O, Aashutosh P, Niranjan P, Hirak P, Chirag P, Roy P, Rakeshkumar P, Danesh P, Deepak P, Tejas P, Tanmaye P, Soumen P, Pratik P, Anshuman P, Pankaj P, Anand P, Arun P, Pallawi P, Gaurav P, Puneet P, Durai R, Santhosh R, Prashant R, Mohsinur R, Mahesh R, Ramesh BS, Gordon R, Prashanth R, Arshad R, Sandip R, Udipta R, Sameer R, Shyam R, Rajendar R, Anand S, ArunKumar S, DineshKumar S, Viswanath S, Amit S, Sajeesh S, Vishal S, Anurag S, Sauradeep S, Ankush S, Snehasish S, Harsh S, Shrenik S, Anil S, Abadhesh S, Meenakshi S, Varsha S, Nikhil S, Harsh S, Pravin S, Vikram SS, Ankur S, Pranav S, Arvind S, Abhishek S, Abhiyutthan S, Chandrapal S, Charan S, Gurbhaij S, Gurbachan S, Saurav S, Harmanmeet S, Pal SS, Kumar SN, Aalok S, Vandana S, Sanjai S, Sushama S, Pravin S, Om T, Fahad T, Ashwin T, Anuroop T, Abhishek T, K TS, Pradeep T, Lohith U, Peeyush V, Ashish V, Ravindra V, Kumar VR, Arunima V, Soumil V, Ajaz W, Sachin W, Amit Y, Kumar YA, Raghu Y, Mohammed Y. Evaluation of 30-day morbidity and mortality of laparoscopic cholecystectomy: a multicenter prospective observational Indian Association of Gastrointestinal Endoscopic Surgeons (IAGES) Study. Surg Endosc 2022; 37:2611-2625. [PMID: 36357547 PMCID: PMC9648883 DOI: 10.1007/s00464-022-09659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/18/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the standard of care for benign gallstone disease. There are no robust Indian data on the 30-day morbidity and mortality of this procedure. A prospective multicentre observational study was conducted by the Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) to assess the 30-day morbidity and mortality of LC in India. MATERIALS AND METHODS Participating surgeons were invited to submit data on all consecutive LCs for benign diseases performed between 09/12/2020 and 08/03/2021 in adults. Primary outcome measures were 30-day morbidity and mortality. Univariate and multivariate analyses were performed to identify variables significantly associated with primary outcomes. RESULTS A total of 293 surgeons from 125 centres submitted data on 6666 patients. Of these, 71.7% (n = 4780) were elective. A total LC was carried out in 95% (n = 6331). Laparoscopic subtotal cholecystectomy was performed in 1.9% (n = 126) and the procedure were converted to open in 1.4% of patients. Bile duct injury was seen in 0.3% (n = 20). Overall, 30-day morbidity and mortality were 11.1% (n = 743) and 0.2% (n = 14), respectively. Nature of practice, ischemic heart disease, emergency surgery, postoperative intensive care, and postoperative hospital stay were independently associated with 30-day mortality. Age, weight, body mass index, duration of symptoms, nature of the practice, history of Coronavirus Disease-2019, previous major abdominal surgery, acute cholecystitis, use of electrosurgical or ultrasonic or bipolar energy for cystic artery control; use of polymer clips for cystic duct control; conversion to open surgery, subtotal cholecystectomy, simultaneous common bile duct exploration, mucocele, gangrenous gall bladder, dense adhesions, intraoperative cholangiogram, and use of drain were independently associated with 30-day morbidity. CONCLUSION LC has 30-day morbidity of 11.1%, 30-day mortality of 0.2%, conversion to open rate of 1.4%, and bile duct injury rate of 0.3% in India.
Collapse
|
28
|
Pizzicannella M, Barberio M, Lapergola A, Gregori M, Maurichi FA, Gallina S, Benedicenti P, Viola MG. One-stage approach to cholecystocholedocholithiasis treatment: a feasible surgical strategy for emergency settings and frail patients. Surg Endosc 2022; 36:8560-8567. [PMID: 35997815 DOI: 10.1007/s00464-022-09537-8] [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: 05/05/2022] [Accepted: 08/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cholecystocholedocholithiasis (CCL) occurs in up to 18% of patients undergoing laparoscopic cholecystectomy (LC). The two-stage treatment using endoscopic retrograde cholangiopancreatography (ERCP) followed by LC is the treatment of choice for CCL. However, only 10 to 60% of patients have common bile duct (CBD) stones at the time of ERCP, thus exposing patients to unnecessary ERCPs, causing 3 to 15% of post-interventional pancreatitis. One-stage laparoscopic-endoscopic rendezvous (LERV) is an alternative for the treatment of CCL. Given the selective top-to-bottom CBD cannulation, LERV reduces the risk of pancreatitis and failed CBD cannulation. Additionally, LERV is performed exclusively in patients presenting CBD stones at intraoperative cholangiography, avoiding unnecessary ERCPs. Despite its advantages, considering the logistical burden of coordinating different specialties, LERV is performed in few centers. Here, we present the largest retrospective series of LERVs performed at our department, analyzing elective and emergency procedures. METHODS All consecutive patients undergoing LERV for CCL between January 2014 and December 2021 were included. LERV success rate, operative time, biliary outflow restoration rate, postoperative complications (POC), length of hospital stay (LOS), and recurrences were analyzed. RESULTS 181 patients were included (61 elective LERVs, 120 emergency LERVs). We reported a 100% LERV success rate, a 97.79% biliary outflow restoration rate, a 0% conversion rate, a mean intraoperative time of 120.17 ± 31.35 min, and LOS of 4.00 ± 2.82 days. POC included 7 Clavien-Dindo type 1, 11 type 2, and 3 type 3 cases. Seven patients presented with CBD stone recurrence: 2 within 30 days after discharge, 3 within 6 months after discharge, and 2 patients at 1 year. No statistically significant difference was found between elective and emergency patients. CONCLUSION LERV is safe, representing a valid option even in emergency settings, thus enabling the management of CCL within a single procedure, consequently sparing additional anesthesia and decreasing post-ERCP complications.
Collapse
Affiliation(s)
- Margherita Pizzicannella
- Endoscopy Unit, Ospedale Card. G. Panico, Tricase, Italy.
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
| | - Manuel Barberio
- General Surgery Department, Ospedale Card. G. Panico, Tricase, Italy
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Alfonso Lapergola
- Department of Visceral and Digestive Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Matteo Gregori
- General Surgery Department, Policlinico Casilino, Rome, Italy
| | | | | | | | | |
Collapse
|
29
|
Mohseni S, Bass GA, Forssten MP, Casas IM, Martin M, Davis KA, Haut ER, Sugrue M, Kurihara H, Sarani B, Cao Y, Coimbra R. Common bile duct stones management: A network meta-analysis. J Trauma Acute Care Surg 2022; 93:e155-e165. [PMID: 35939370 DOI: 10.1097/ta.0000000000003755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Timely management is critical for treating symptomatic common bile duct (CBD) stones; however, a single optimal management strategy has yet to be defined in the acute care setting. Consequently, this systematic review and network meta-analysis, comparing one-stage (CBD exploration or intraoperative endoscopic retrograde cholangiopancreatography [ERCP] with simultaneous cholecystectomy) and two-stage (precholecystectomy or postcholecystectomy ERCP) procedures, was undertaken with the main outcomes of interest being postprocedural complications and hospital length of stay (LOS). METHODS PubMed, SCOPUS, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were methodically queried for articles from 2010 to 2021. The search terms were a combination of medical subject headings terms and the subsequent terms: gallstone; common bile duct (stone); choledocholithiasis; cholecystitis; endoscopic retrograde cholangiography/ERCP; common bile duct exploration; intraoperative, preoperative, perioperative, and postoperative endoscopic retrograde cholangiography; stone extraction; and one-stage and two-stage procedure. Studies that compared two procedures or more were included, whereas studies not recording complications (bile leak, hemorrhage, pancreatitis, perforation, intra-abdominal infections, and other infections) or LOS were excluded. A network meta-analysis was conducted to compare the four different approaches for managing CBD stones. RESULTS A total of 16 studies (8,644 participants) addressing the LOS and 41 studies (19,756 participants) addressing postprocedural complications were included in the analysis. The one-stage approaches were associated with a decrease in LOS compared with the two-stage approaches. Common bile duct exploration demonstrated a lower overall risk of complications compared with preoperative ERCP, but there were no differences in the overall risk of complications in the remaining comparisons. However, differences in specific postprocedural complications were detected between the four different approaches managing CBD stones. CONCLUSION This network meta-analysis suggests that both laparoscopic CBD exploration and intraoperative ERCP have equally good outcomes and provide a preferable single-anesthesia patient pathway with a shorter overall length of hospital stay compared with the two-stage approaches. LEVEL OF EVIDENCE Systematic Review/Meta Analysis; Level III.
Collapse
Affiliation(s)
- Shahin Mohseni
- From the Division of Trauma and Emergency Surgery, Department of Surgery (S.M., M.P.F.), Orebro University Hospital; School of Medical Sciences, Orebro University (S.M., G.A.B., M.P.F.), Orebro, Sweden; Division of Traumatology, Surgical Critical Care and Emergency Surgery (G.A.B.), Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania; Servicio de Cirugía General y Digestiva, Unidad de Cirugía de Urgencias y Trauma (I.M.C.), Hospital Universitario Virgen del Rocio, Sevilla, Andalucia, Spain; Division of Acute Care Surgery (M.M.), Los Angeles County + USC Medical Center, Uniformed Services University Health Sciences, Los Angeles, California; Division of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (K.A.D.), Yale School of Medicine, New Haven, Connecticut; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine; Department of Health Policy and Management (E.R.H.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Letterkenny Hospital (M.S.), Galway University, Galway, Ireland; UOSD Chirurgia d'Urgenza (H.K.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC; Clinical Epidemiology and Biostatistics (Y.C.), School of Medical Sciences, Orebro University, Orebro, Sweden; Department of Surgery, Riverside University Health System Medical Center (R.C.); Department of Surgery, Loma Linda University School of Medicine (R.C.), Loma Linda; and Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center (R.C.), California
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Boni L, Huo B, Alberici L, Ricci C, Tsokani S, Mavridis D, Amer YS, Andreou A, Berriman T, Donatelli G, Forbes N, Kapiris S, Kayaalp C, Kylänpää L, Parra-Membrives P, Siersema PD, Black GF, Antoniou SA. EAES rapid guideline: updated systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on the management of common bile duct stones. Surg Endosc 2022; 36:7863-7876. [PMID: 36229556 DOI: 10.1007/s00464-022-09662-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Choledocholithiasis presents in a considerable proportion of patients with gallbladder disease. There are several management options, including preoperative or intraoperative endoscopic cholangiopancreatography (ERCP), and laparoscopic common bile duct exploration (LCBDE). OBJECTIVE To develop evidence-informed, interdisciplinary, European recommendations on the management of common bile duct stones in the context of intact gallbladder with a clinical decision to intervene to both the gallbladder and the common bile duct stones. METHODS We updated a systematic review and network meta-analysis of LCBDE, preoperative, intraoperative, and postoperative ERCP. We formed evidence summaries using the GRADE and the CINeMA methodology, and a panel of general surgeons, gastroenterologists, and a patient representative contributed to the development of a GRADE evidence-to-decision framework to select among multiple interventions. RESULTS The panel reached unanimous consensus on the first Delphi round. We suggest LCBDE over preoperative, intraoperative, or postoperative ERCP, when surgical experience and expertise are available; intraoperative ERCP over LCBDE, preoperative or postoperative ERCP, when this is logistically feasible in a given healthcare setting; and preoperative ERCP over LCBDE or postoperative ERCP, when intraoperative ERCP is not feasible and there is insufficient experience or expertise with LCBDE (weak recommendation). The evidence summaries and decision aids are available on the platform MAGICapp ( https://app.magicapp.org/#/guideline/nJ5zyL ). CONCLUSION We developed a rapid guideline on the management of common bile duct stones in line with latest methodological standards. It can be used by healthcare professionals and other stakeholders to inform clinical and policy decisions. GUIDELINE REGISTRATION NUMBER IPGRP-2022CN170.
Collapse
Affiliation(s)
- Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Policlinico di Milano, Milan, Italy
| | - Bright Huo
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Laura Alberici
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Sorbonne Paris Cité, Faculté de Médecine, Paris Descartes University, Paris, France
| | - Yasser Sami Amer
- Pediatrics Department, and Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Guidelines International Network, Perth, Scotland Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Alexandros Andreou
- Department of Surgery, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Thomas Berriman
- Department of Gastroenterology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Gianfranco Donatelli
- Hôpital Privé Des Peupliers, Unité d'Endoscopie Interventionnelle, Ramsay Santé, Paris, France
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Nauzer Forbes
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Stylianos Kapiris
- Third Department of Surgery, Evangelismos General Hospital, Athens, Greece
| | - Cüneyt Kayaalp
- Gastrointestinal Surgery, Yeditepe University Medical School, Istanbul, Turkey
| | - Leena Kylänpää
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pablo Parra-Membrives
- Department of General and Digestive Surgery, Valme University Hospital, Seville, Spain
- Department of Surgery, University of Seville, Seville, Spain
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Stavros A Antoniou
- European University Cyprus, Nicosia, Cyprus.
- EAES Guidelines Subcommittee, Veldhoven, The Netherlands.
| |
Collapse
|
31
|
Niu H, Liu F, Tian YB. Clinical observation of laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography or common bile duct lithotripsy. World J Clin Cases 2022; 10:10931-10938. [PMID: 36338212 PMCID: PMC9631154 DOI: 10.12998/wjcc.v10.i30.10931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 09/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The incidence of common bile duct (CBD) stones accounts for approximately 10%–15% of all CBD diseases. Approximately 8%–20% of these patients also have gallstones with heterogenous signs and symptoms.
AIM To investigate the clinical effects of laparoscopic cholecystectomy (LC) combined with endoscopic retrograde cholangiopancreatography (ERCP) and LC with CBD excision and stone extraction in one-stage suture (LBEPS) for the treatment of gallbladder and CBD stones.
METHODS Ninety-four patients with gallbladder and CBD stones were selected from our hospital from January 2018 to June 2021. They were randomly divided into study and control groups with 47 patients each. The study group underwent LC with ERCP, and the control group underwent LC with LBEPS. Surgery, recovery time of gastrointestinal function, complication rates, liver function indexes, and stress response indexes were measured pre- and postoperatively in both the groups.
RESULTS The durations of treatment and hospital stay were shorter in the study group than in the control group. There was no significant difference between the one-time stone removal rate between the study and control groups. The time to anal evacuation, resumption of oral feeding, time to bowel sound recovery, and time to defecation were shorter in the study group than in the control group. The preoperative serum direct bilirubin (DBIL), total bilirubin (TBIL), and alanine aminotransferase (ALT) levels were insignificantly higher in the study group than that in the control group. A day after surgery, the postoperative serum DBIL, TBIL, and ALT levels were lower than their preoperative levels in both groups, and of the two groups, the levels were lower in the study group. Although the preoperative serum adrenocorticotrophic (ACTH), cortisol (COR), epinephrine (A), and norepinephrine (NE) levels were higher in the study group than that in the control group, these differences were not significant (P > 0.05). The serum ACTH, COR, A, and NE levels in both groups decreased one day after surgery compared to the preoperative levels, but the inter-group difference was statistically insignificant. Similarly, (91.79 ± 10.44) ng/mL, A, and NE levels were lower in the study group than in the control group. The incidence of complications was lower in the study group than in the control group.
CONCLUSION LC combined with ERCP induces only a mild stress response; this procedure can decrease the risk of complications, improve liver function, and achieve and promote a faster recovery of gastrointestinal functions.
Collapse
Affiliation(s)
- Hong Niu
- Department of Gastroenterology, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
| | - Fei Liu
- Department of General Surgery, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
| | - Yi-Bo Tian
- Department of Emergency, Jincheng General Hospital, Jincheng 048000, Shanxi Province, China
| |
Collapse
|
32
|
Kattih O, Velanovich V. Comparing One-Stage vs Two-Stage Approaches for the Management of Choledocholithiasis. J Gastrointest Surg 2022; 27:534-543. [PMID: 36127555 DOI: 10.1007/s11605-022-05458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The management of symptomatic choledocholithiasis remains a controversial issue. At present, the three most common management options for choledocholithiasis include a preoperative endoscopic retrograde cholangiopancreatography with sphincterotomy and stone extraction followed by laparoscopic cholecystectomy, then by either an intraoperative endoscopic retrograde cholangiopancreatography with sphincterotomy or a laparoscopic common bile duct exploration. The purpose of this study was to assess the consequences of the decision to pursue each of these three methods. METHODS We conducted a review of the existing data comparing these three management options. The literature from 2009 to 2021 pertaining to these three methods was reviewed for data on duct clearance, morbidity, mortality, recurrence rate, length of stay, and operative time. Next, we constructed decision trees for each method using a utility score analysis, and these utility scores were used to create a sensitivity analysis based on stone clearance rate. RESULTS Laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography had a utility score of 0.9910, a stone clearance rate of 95.5%, a morbidity of 6.3%, and a mortality of 0.2%. Preoperative endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy had a utility score of 0.9629, a stone clearance rate of 85.5%, a morbidity of 13.3%, and a mortality of 0.8%. Laparoscopic cholecystectomy with common bile duct exploration had a utility score of 0.9882, a stone clearance rate of 88.3%, a morbidity of 12.9%, and a mortality of 0.3%. CONCLUSION We have shown that a laparoscopic cholecystectomy with an intraoperative endoscopic retrograde cholangiopancreatography is associated with the best overall outcomes.
Collapse
Affiliation(s)
- Obada Kattih
- Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Five Tampa General Circle 740, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, University of South Florida Morsani College of Medicine, Five Tampa General Circle 740, Tampa, FL, 33606, USA.
| |
Collapse
|
33
|
Lithotripsy-Assisted Bile Duct Exploration by Laparoendoscopy (LABEL): An Alternative for Peroral Lithotripsy for Complex Bile Duct Stones with Gallbladder In Situ : Comment on "Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 Patients". Dig Dis Sci 2022; 67:4590-4592. [PMID: 35534744 DOI: 10.1007/s10620-022-07515-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/09/2022]
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Laparo-Endoscopic Rendez-Vous in the Treatment of Cholecysto-Choledocolithiasis in the Pediatric Population. J Pediatr Gastroenterol Nutr 2022; 74:819-822. [PMID: 35258502 DOI: 10.1097/mpg.0000000000003444] [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] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The incidence of choledocolithiasis is reported to be increasing in children. As for the adult population, several different therapeutic strategies have been described, however it is unclear which of those should be considered the gold standard. There is evidence-based literature in adults that supports a combined "rendez-vous" endoscopic retrograde cholangiopancreatography-laparoscopic cholecystectomy technique. This allows management of the choledocholithiasis during the same anesthetic episode as the cholecystectomy. By contrast, there are just two case reports in children reporting this approach. The aim of this study is to report our experience with this technique in a series of children with choledocholithiasis. METHODS All patients who underwent the "rendez-vous technique" at our institution between 2009 and 2020 were reviewed and evaluated for outcomes and complications. RESULTS Eleven children with cholecysto-choledocholithiasis were evaluated: the procedure was successful in 10 whereas in one patient it was aborted due to technical difficulties. All patients resolved their clinical condition without major complications. CONCLUSION To our knowledge, this is the first consistent series of "rendez-vous technique" in the pediatric population, proving its feasibility and safety.
Collapse
|
36
|
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.
Collapse
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
| |
Collapse
|
37
|
Inpatient Choledocholithiasis Management: a Cost-Effectiveness Analysis of Management Algorithms. J Gastrointest Surg 2022; 26:837-848. [PMID: 35083722 DOI: 10.1007/s11605-022-05249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Choledocholithiasis is commonly encountered. It is frequently managed with laparoscopic common bile duct exploration or endoscopic retrograde cholangiopancreatography (either preoperative, intraoperative, or postoperative relative to laparoscopic cholecystectomy). The purpose of this study is to determine the most cost-effective method to manage inpatient choledocholithiasis. METHODS A decision tree model was created to evaluate the cost-effectiveness of laparoscopic common bile duct exploration and preoperative, intraoperative, and postoperative endoscopic retrograde cholangiopancreatography. The primary outcome was incremental cost-effectiveness ratio with a ceiling willingness to pay threshold assumed of $100,000 per quality-adjusted life year. Model parameters were determined through review of published literature and institutional data. Costs were from the perspective of the healthcare system with a time horizon of 1 year. Sensitivity analyses were performed on model parameters. RESULTS In the base case analysis, laparoscopic common bile duct exploration was cost-effective, resulting in 0.9909 quality-adjusted life years at an expected cost of $18,357. Intraoperative endoscopic retrograde cholangiopancreatography yielded more quality-adjusted life years (0.9912) at a higher cost ($19,717) with an incremental cost-effectiveness ratio of $4,789,025, exceeding the willingness to pay threshold. Both preoperative and postoperative endoscopic retrograde cholangiopancreatographies were eliminated for being both more costly and less effective. Laparoscopic common bile duct exploration remained cost-effective if the probability of successful biliary clearance was above 0.79, holding all other variables constant. If its base cost remained below $18,400 and intraoperative endoscopic retrograde cholangiopancreatography base cost rose above $18,200, then laparoscopic common bile duct exploration remained cost-effective. CONCLUSION Laparoscopic common bile duct exploration is the most cost-effective method to manage choledocholithiasis. Efforts to ensure availability of local expertise and resources for this procedure are warranted.
Collapse
|
38
|
[Temporal sequence of bile duct clearance with simultaneous cholecystolithiasis or choledocholithiasis-Preoperative, intraoperative or postoperative?]. Chirurg 2022; 93:542-547. [PMID: 35107623 DOI: 10.1007/s00104-022-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 02/07/2023]
Abstract
Approximately 10% of patients with symptomatic cholecystolithiasis also have choledocholithiasis. The probability of this can be estimated on the basis of sonographic and laboratory chemistry parameters. If the probability is high, endoscopic retrograde cholangiography (ERC) or cholangiopancreatography (ERCP) should be performed and if the probability is low, cholecystectomy can be performed without further diagnostics. If the findings are equivocal, further work-up should be performed to detect or exclude choledocholithiasis by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP). If choledocholithiasis is detected, it can be treated by ERC preoperatively, intraoperatively or postoperatively or alternatively by laparoscopic cholangiography. Regarding the temporal sequence, there is no clear advantage of a specific time point; however, considering the high availability of ERCP in German-speaking countries, preoperative clearance of choledocholithiasis seems reasonable. With respect to the time interval between clearance of choledocholithiasis and cholecystectomy, a number of multicenter studies and a meta-analysis have shown that a short time interval or a procedure during the same period of hospitalization is advantageous.
Collapse
|
39
|
Alberici L, Ingaldi C, Ricci C, Selva S, Di Dalmazi G, Vicennati V, Pagotto U, Casadei R, Minni F. Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials. Langenbecks Arch Surg 2022; 407:285-296. [PMID: 35022834 PMCID: PMC8847275 DOI: 10.1007/s00423-022-02431-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The best approach for minimally invasive adrenalectomy is still under debate. METHODS A systematic search of randomized clinical trials was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both in-hospital mortality and morbidity. The secondary endpoints were operative time (OP), blood loss (BL), length of stay (LOS), conversion, incisional hernia, and disease recurrence rate. RESULTS Eight studies were included, involving 359 patients clustered as follows: 175 (48.7%) in the TPLA arm; 55 (15.3%) in the RPLA arm; 10 (2.8%) in the Ro-TPLA arm; 25 (7%) in the TPAA arm; 20 (5.6%) in the SILS-LA arm; and 74 (20.6%) in the RPA arm. The RPLA had the highest probability of being the safest approach (SUCRA 69.6%), followed by RPA (SUCRA 63.0%). TPAA, Ro-TPLA, SILS-LA, and TPLA have similar probability of being safe (SUCRA values 45.2%, 43.4%, 43.0%, and 38.5%, respectively). Analysis of the secondary endpoints confirmed the superiority of RPA regarding OP, BL, LOS, and incisional hernia rate. CONCLUSIONS The best choice for patients with adrenal masses candidate for minimally invasive surgery seems to be RPA. An alternative could be RPLA. The remaining approaches could have some specific advantages but do not represent the first minimally invasive choice.
Collapse
Affiliation(s)
- Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia.
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università Di Bologna, IRCCS, Policlinico S.Orsola-Malpighi, Via Massarenti n.9 40138, Bologna, Italy.
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Valentina Vicennati
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Uberto Pagotto
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| |
Collapse
|
40
|
Endoscopic Stone Extraction followed by Laparoscopic Cholecystectomy in Tandem for Concomitant Cholelithiasis and Choledocholithiasis: A Prospective Study. J Clin Exp Hepatol 2022; 12:129-134. [PMID: 35068793 PMCID: PMC8766527 DOI: 10.1016/j.jceh.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/12/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Single-session endoscopic stone extraction (ESE) and laparoscopic cholecystectomy (LC) has the best outcome in managing concomitant cholelithiasis (gallstone disease [GSD]) and choledocholithiasis (common bile duct stone [CBDS]). Traditional rendezvous technique with an intraoperative cholangiogram is associated with various technical (bowel distention, frozen Calot's triangle, limitation of intraoperative cholangiogram and so on) and logistical difficulties (lack of trained personnel and equipment for ESE in the operating room). We modified our approach of ESE-LC (tandem ESE-LC) to study the safety of the approach and overcome these disadvantages of the traditional rendezvous approach. METHODS A prospective study of patients with GSD and suspected CBDS from January 2017 to December 2019 was conducted. Tandem ESE-LC involves ESE and LC under the same general anaesthesia in a single day, while ESE is performed in the endoscopic suite using carbon dioxide insufflation, a balloon/basket was used for achieving bile duct clearance and the same was confirmed with an occlusion cholangiogram. Patients were then shifted to the operating room for LC. The primary outcome included bile duct clearance and safety of the procedure. RESULTS Of 56 patients assessed for eligibility, 42 were included in the study (median age: 53 years, 25 [60%] women). Biliary colic was the most common presenting symptom (n = 24, 57%), followed by acute cholecystitis (n = 11, 26%). The median number of stones and stone size was 1 (1-6) and 4 mm (3-10), respectively. All patients had successful bile duct clearance. Stenting was performed in 5 (12%) patients. Intraoperatively, Calot's dissection was difficult and frozen in 10 and 11 patients respectively. The cystic duct was short and wide in 13 (31%) patients. Subtotal cholecystectomy was performed in 6 (14%) patients. The median duration of postprocedural hospital stay was 1 (0-13) day. Three patients had tandem ESE-LC on a day-care basis. One patient had post-endoscopic retrograde cholangiopancretography pancreatitis, and another required percutaneous drainage for gall bladder fossa collection. No patient had retained CBDS at a median follow-up of 18 (3-28) months. CONCLUSION Tandem ESE-LC is safe and effective method in managing concomitant GSD and CBDS.
Collapse
Key Words
- ASGE, American Society for Gastrointestinal Endoscopy
- CBD stones
- CBDS, common bile duct stone
- ERC, endoscopic retrograde cholangiography
- ERCP, endoscopic retrograde cholangiopancretography
- ESE, endoscopic stone extraction
- GB, gall bladder
- GSD, gallstone disease
- LC, laparoscopic cholecystectomy
- OR, operating room
- POD, postoperative day
- SIRS, systemic inflammatory response syndrome
- TAP, transversus abdominis plane
- bile duct clearance
- rendezvous
- retained stones
- single sitting
Collapse
|
41
|
Gangu K, Bobba A, Chela HK, Basar O, Min RW, Tahan V, Daglilar E. Cutting out Cholecystectomy on Index Hospitalization Leads to Increased Readmission Rates, Morbidity, Mortality and Cost. Diseases 2021; 9:diseases9040089. [PMID: 34940027 PMCID: PMC8699900 DOI: 10.3390/diseases9040089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Biliary tract diseases that are not adequately treated on index hospitalization are linked to worse outcomes, including high readmission rates. Delays in care for conditions such as choledocholithiasis, gallstone pancreatitis, and cholecystitis often occur due to multiple reasons, and this delay is under-appreciated as a source of morbidity and mortality. Our study is based on the latest Nationwide Readmissions Database review and evaluated the effects of postponing definitive management to a subsequent visit. The study shows a higher 30-day readmission rate in addition to increased mortality rate, intubation rate, vasopressor use in this patient population and significantly added financial burden.
Collapse
Affiliation(s)
- Karthik Gangu
- Division of Hospital Medicine, Department of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Aniesh Bobba
- Division of Hospital Medicine, Department of Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60612, USA;
| | - Harleen Kaur Chela
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
| | - Omer Basar
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
| | - Robert W. Min
- Department of Medicine, Rush Medical Collage, Chicago, IL 60612, USA;
| | - Veysel Tahan
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
- Correspondence: (V.T.); (E.D.)
| | - Ebubekir Daglilar
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA; (H.K.C.); (O.B.)
- Correspondence: (V.T.); (E.D.)
| |
Collapse
|
42
|
Wang Y, Huang Y, Shi C, Wang L, Liu S, Zhang J, Wang W. Efficacy and safety of laparoscopic common bile duct exploration via choledochotomy with primary closure for the management of acute cholangitis caused by common bile duct stones. Surg Endosc 2021; 36:4869-4877. [PMID: 34724579 PMCID: PMC9160116 DOI: 10.1007/s00464-021-08838-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/21/2021] [Indexed: 12/07/2022]
Abstract
Background T-tube drainage after laparoscopic common bile duct exploration (LCBDE) has been demonstrated to be safe and effective for patients with acute cholangitis caused by common bile duct stones (CBDSs). The outcomes after LCBDE with primary closure in patients with CBDS-related acute cholangitis are unknown. The present study aimed to evaluate the efficacy and safety of LCBDE with primary closure for the management of acute cholangitis caused by CBDSs. Methods Between June 2015 and June 2020, 368 consecutive patients with choledocholithiasis combined with cholecystolithiasis, who underwent laparoscopic cholecystectomy (LC) + LCBDE in our department, were retrospectively reviewed. A total of 193 patients with CBDS-related acute cholangitis underwent LC + LCBDE with primary closure of the CBD (PC group) and 62 patients underwent LC + LCBDE followed by T-tube placement (T-tube group). A total of 113 patients who did not have cholangitis were excluded. The clinical data were compared and analyzed. Results There was no mortality in either group. No significant differences were noted in morbidity, bile leakage rate, retained CBD stones, or readmission rate within 30 days between the two groups. Compared with the T-tube group, the PC group avoided T-tube-related complications and had a shorter operative time (121.12 min vs. 143.37 min) and length of postoperative hospital stay (6.59 days vs. 8.81 days). Moreover, the hospital expenses in the PC group were significantly lower than those in the T-tube group ($4844.47 vs. $5717.22). No biliary stricture occurred during a median follow-up of 18 months in any patient. No significant difference between the two groups was observed in the rate of stone recurrence. Conclusions LCBDE with primary closure is a safe and effective treatment for cholangitis caused by CBDSs. LCBDE with primary closure is not inferior to T-tube drainage for the management of CBDS-related acute cholangitis in suitable patients.
Collapse
Affiliation(s)
- Yanjun Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Youbao Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Chunfeng Shi
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Linpei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Shengwei Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Jiawei Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China
| | - Wei Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshanbei Road, Quanzhou, 362000, China.
| |
Collapse
|
43
|
Intraoperative cholangiography: a stepping stone to streamlining the treatment of choledocholithiasis. Surg Endosc 2021; 36:4885-4892. [PMID: 34724581 DOI: 10.1007/s00464-021-08840-0] [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: 04/06/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An estimated 8-15% of patients undergoing cholecystectomy have concomitant common bile duct stones. In this 14-year study, we utilize data of patients at a high-volume tertiary care academic center and compare the clinical outcomes of patients undergoing intraoperative cholangiography (IOC) and endoscopic retrograde pancreatography (ERCP). METHODS The charts of 1715 patients in the institutional NSQIP database who underwent cholecystectomy between October 1st, 2005 and September 30th, 2019 were retrospectively reviewed. Patients who underwent cholecystectomy in relation to a malignancy diagnosis or who underwent an ERCP in a different index hospitalization were excluded. Main outcomes included hospital length of stay (LOS), post-operative morbidity, and rate of readmissions. RESULTS Of the 1409 patients included in the final analysis, 185 patients underwent ERCP, while 95 patients underwent IOC. Use of IOC compared to preoperative ERCP resulted in a shorter LOS (2.6 vs. 5.3 days, p < 0.001), lower rate of readmission (1.1% vs. 6.5%, p = 0.040), and similar rates of post-operative complications. Mean operative time increased by only 15 min in the IOC compared to the ERCP group (129 vs.114 min, p = 0.047). Additional variables that increased LOS on multivariable logistic regression included age, ASA classification, post-operative complications, and increased number of preoperative tests. CONCLUSIONS This study demonstrates that use of IOC during cholecystectomy results in shorter LOS and fewer readmissions compared to ERCP. Future studies comparing these two approaches should focus on patient randomization, a cost-effectiveness analysis, and identifying barriers to implementation of a one-stage approach in the management of suspected choledocholithiasis.
Collapse
|
44
|
Abstract
PURPOSE The prevalence of gallstones in children has increased over the last years. Choledocholithiasis (CD) is present in up to 30% of the cases. There is a scarcity of studies on the management of choledocholithiasis in children. The aim of this study was to develop a score that would allow predicting accurately the risk of CD in children with gallstones and reduce the number of non-therapeutic ERCP. MATERIALS AND METHODS We conducted a retrospective study in children with gallstones and suspected CD seen between January 2010 and December 2019. The main outcome was the presence of CD confirmed by at least one of the following diagnostic tests: magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and/or intraoperative cholangiography (IOC). We developed a risk score based on the presence or absence of the following risk factors: acute biliary pancreatitis, ascending cholangitis, elevated liver function tests (AST, ALT, total bilirubin [TB, ≥ 2 mg/dl], conjugated bilirubin, gamma-glutamyl transpeptidase, and alkaline phosphatase), CD on ultrasound (US; this was considered predictive but not confirmatory of CD), and dilation of the common bile duct (> 6 mm) by US. The score was divided into three different categories: low risk (no risk factors), intermediate risk (one risk factor present), high risk (≥ 2 risk factors present or ascending cholangitis). Given the main goal of reducing the number of diagnostic ERCPs, a very-high-risk subgroup (3 risk factors present or ascending cholangitis) was identified. RESULTS We reviewed 133 patients with gallstones and suspected CD. In 56 (42.1%) patients, the presence of CD was confirmed by one or more of the definitive diagnostic tests (MRCP, ERCP, and IOC). The following variables were found to be the strongest predictors of CD: ascending cholangitis, TB ≥ 2 mg/dl, common bile duct > 6 mm, and the presence of CD by US. The positive predictive value for CD was 7.5% in the low-risk group (OR 0.06, P = < 0.001); 22.9% in the intermediate-risk group (OR 0.31, P = 0.007); 77.6% in the high-risk group (OR 20.14, P = < 0.001); and 95.7% in very-high-risk subgroup (OR 49.18, P = < 0.001). CONCLUSION The risk score proposed in this study predicts accurately the presence of CD in children with gallstones. It can serve as a helpful tool to triage the need for costly and complex studies in the workup of CD, particularly in centers with limited resources. Finally, due to its high specificity and positive predictive value (PPV), the use of the very-high-risk criteria would allow for an important decrease in the number of non-therapeutic ERCP.
Collapse
|
45
|
Abstract
Cholecystectomy is one of the most common general surgery procedures performed worldwide. Complications include bile duct injury, strictures, bleeding, infection/abscess, retained gallstones, hernias, and postcholecystectomy syndrome. Obtaining a critical view of safety and following the other tenets of the Safe Cholecystectomy Task Force will aid in the prevention of bile duct injury and other morbidity associated with cholecystectomy.
Collapse
Affiliation(s)
- Xiaoxi Chelsea Feng
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Edward Phillips
- Department of Surgery, Cedars Sinai Medical Center, 8635 W Third Street, West Medical Office Tower, Suite 795, Los Angeles, CA 90048, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars Sinai Medical Center, 459 North Croft Avenue, Los Angeles, CA 90048, USA.
| |
Collapse
|
46
|
Lei C, Lu T, Yang W, Yang M, Tian H, Song S, Gong S, Yang J, Jiang W, Yang K, Guo T. Comparison of intraoperative endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treating gallstones and common bile duct stones: a systematic review and meta-analysis. Surg Endosc 2021; 35:5918-5935. [PMID: 34312727 DOI: 10.1007/s00464-021-08648-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC-IntraERCP) and laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration (LC-LCBDE) to determine which one-stage therapeutic strategy provides better outcomes for patients with gallstones and common bile duct stones. METHODS Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to identify eligible articles from the database inception to September 2020. The revised Cochrane risk of bias tools for randomized trials (RoB-2) and non-randomized interventions (ROBINS-I) was used to assess the quality of the included studies. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The primary outcomes consisted of surgical success, retained stones, and overall postoperative complications, while secondary outcomes included postoperative bleeding, postoperative pancreatitis, postoperative bile leakage, conversion to laparotomy, and operative time. RESULTS Eight studies (four RCTs and four Non-RCTs with high quality) with 2948 patients were included. No significant difference was seen between the two groups regarding surgical success, overall postoperative complications, conversion to laparotomy, and operative time. The meta-analysis demonstrated that in the LC-IntraERCP group, the rate of retained stones (OR 0.51, 95% CI 0.28-0.91) and postoperative bile leakage were lower (OR 0.25, 95% CI 0.09-0.69), while in the LC-LCBDE group, postoperative bleeding (OR 5.24, 95% CI 1.65-16.65) and postoperative pancreatitis (OR 4.80, 95% CI 2.35-9.78) decreased. CONCLUSIONS LC-IntraERCP and LC-LCBDE exhibited similar efficacies when surgical success rate, overall postoperative complications, conversion to laparotomy, and operative time were compared. However, LC-IntraERCP is probably to be more effective in terms of lowering the rate of retained stones.
Collapse
Affiliation(s)
- Caining Lei
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenwen Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Man Yang
- The Affiliated Cancer Hosptial School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China
| | - Shaoming Song
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenjie Jiang
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China. .,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
| | - Tiankang Guo
- The First Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, 730000, China. .,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China. .,Key Laboratory of Surgical Tumor Molecular Diagnosis and Precision Therapy in Gansu Province, Lanzhou, 730000, China.
| |
Collapse
|
47
|
Factors predictive of the successful treatment of choledocholithiasis. Surg Endosc 2021; 36:1838-1846. [PMID: 33825014 DOI: 10.1007/s00464-021-08463-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Choledocholithiasis is a common complication of cholelithiasis, occurring in up to 18% of patients. Multiple treatments are often performed during the course of the management of choledocholithiasis, sometimes without success. Our study was performed identify the factors predictive of the success of treatment with retrograde endoscopic cholangiopancreatography (ERCP). METHODS This was a retrospective, case-control study that used data from a biliary disease database at Hospital de Clínicas de Porto Alegre (HCPA). Demographic, clinical, radiological and procedure-related variables were compared between patients with successful biliary clearance after one ERCP procedure (Group 1) and those with unsuccessful biliary clearance after one ERCP procedure (Group 2). RESULTS Three hundred twenty patients were included in Group 1, while 254 were included in Group 2. Multivariate analysis showed that older age, previous biliary exploration, elevated serum total bilirubin, choledocholithiasis above the level of the confluence of the hepatic ducts, stones retained in the cystic duct or Mirizzi syndrome, dilatation of the bile duct diagnosed during ERCP, and the need for suprapapillary opening were independently associated with the failure of the first ERCP to achieve bile duct clearance. The performance of imaging at the same institution prior to the procedure and the retention of stones in the duodenal papilla were associated with the success of endoscopic treatment. CONCLUSIONS The variables identified in this study, when considered in conjunction with the results of previously published studies, can be used to guide the choice of therapeutic methods for patients with choledocholithiasis in the future, given the significant difference in outcomes between the two groups. In the future, a prospective study should be performed to determine whether the same factors are predictive of the success of other methods of treatment (surgical or percutaneous).
Collapse
|
48
|
Alvarez chica LF, Rico-Juri JM, Carrero-Rivera SA, Castro-Villegas F. Coledocolitiasis y exploración laparoscópica de la vía biliar. Un estudio de cohorte. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.558] [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 coledocolitiasis es la presencia de cálculos en las vías biliares. En la mayoría de los casos se trata mediante la colangio pancreatografía retrógrada endoscópica y menos comúnmente por intervención quirúrgica laparoscópica. El objetivo de este estudio fue describir una cohorte retrospectiva de pacientes sometidos a exploración laparoscópica de la vía biliar.
Métodos. Se incluyeron pacientes intervenidos entre los años 2014 y 2018, en dos instituciones de nivel III en Cali, Colombia, referidos para valoración por cirugía hepato-biliar, por dificultad para la extracción de los cálculos por colangio pancreatografia retrograda endoscópica, debido al tamaño, la cantidad, o la dificultad para identificar o canular la papila duodenal.
Resultados. De los 100 pacientes incluidos, se encontró que el 72 % fueron mujeres, con rango de edad entre 14 y 92 años. Al 39 % de los pacientes se les extrajo un solo cálculo y al 16 % 10 cálculos. Un 12 % presentaron cálculos gigantes (mayores de 2,5 cm de ancho) y un 44 % presentaron litiasis múltiple. Al 69 % de los pacientes se les realizó colecistectomía. El porcentaje de éxito de limpieza de la vía biliar por laparoscopia fue del 95 %.
Discusión. La exploración laparoscópica de la vía biliar es una técnica posible, reproducible, segura y con excelentes resultados para el manejo de la coledocolitiasis.
Collapse
|
49
|
Treatment for Infected Pancreatic Necrosis Should be Delayed, Possibly Avoiding an Open Surgical Approach: A Systematic Review and Network Meta-analysis. Ann Surg 2021; 273:251-257. [PMID: 31972645 DOI: 10.1097/sla.0000000000003767] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate all invasive treatments for suspected IPN. SUMMARY OF BACKGROUND DATA The optimal invasive treatment for suspected IPN remains unclear. METHODS A systematic search of randomized clinical trials comparing at least 2 invasive strategies for the treatment of suspected IPN was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both the in-hospital mortality and major morbidity rates. The secondary endpoints were mortality, length of stay, intensive care unit stay, the pancreatic fistula rate, and exocrine and endocrine insufficiency. RESULTS Seven studies were included, involving 400 patients clustered as following: 64 (16%) in early surgical debridement (ED); 27 (6.7%) in peritoneal lavage (PL); 45 (11.3%) in delayed surgical debridement (DD), 169 (42.3%) in the step-up approach with minimally invasive debridement (SUA-DD) and 95 (23.7%) with endoscopic debridement (SUA-EnD). The step-up approach with endoscopic debridement had the highest probability of being the safest approach (SUCRA 87.1%), followed by SUA-DD (SUCRA 59.5%); DD, ED, and PL had the lowest probability of being safe (SUCRA values 27.6%, 31.4%, and 44.4%, respectively). Analysis of the secondary endpoints confirmed the superiority of SUA-EnD regarding length of stay, intensive care unit stay, pancreatic fistula rate, and new-onset diabetes. The SUA approaches are similar regarding exocrine function. Mortality was reduced by any delayed approaches (DD, SUA-DD, or SUA-EnD). CONCLUSIONS The first choice for suspected IPN seemed to be SUA-EnD. An alternative could be SUA-DD. PL, ED, and DD should be avoided.
Collapse
|
50
|
Brewer JO, Navaratne L, Marchington SW, Martínez Cecilia D, Quiñones Sampedro J, Muñoz Bellvis L, Isla AM. Porcine Aorto-Renal Artery (PARA) model for laparoscopic transcystic common bile duct exploration: the evolution of a training model to meet new clinical needs. Langenbecks Arch Surg 2021; 406:1149-1154. [PMID: 33595704 PMCID: PMC8208912 DOI: 10.1007/s00423-020-02045-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/25/2020] [Indexed: 10/29/2022]
Abstract
BACKGROUND The transcystic approach to laparoscopic common bile duct exploration has gained popularity for the single-stage management of choledocholithiasis with concomitant gallstones. Our team previously described the use of a porcine aorta segment to simulate the common bile duct during laparoscopic skill training. METHODS With the advent of the transcystic approach as a contender for the first-line technique of accessing the common bile duct, we present an evolution of the laparoscopic training model using a Porcine Aorta-Renal Artery (PARA) specimen to simulate the structural integrity, dimensions and spatial distribution of both the human cystic and common bile ducts. RESULTS This training model allows the use of a choledochoscope for transcystic exploration of the biliary tree. It combines fidelity and reproducibility required for a simulated training model to offer experience in laparoscopic transcystic common bile duct exploration. Validation of the model was demonstrated by 21 surgeons who completed a questionnaire after performing the simulated procedure. In all sections assessing reliability, face validity and content validity of the model, mean rating scores were between 4 and 5 out of five (good or excellent). CONCLUSIONS We present the evolution of an established training model for laparoscopic common bile duct exploration which focusses the attention on the transcystic approach to the common bile duct and the use of lithotripsy techniques. The need for such a model reflects the shift in the current practice of the laparoendoscopic management of choledocholithiasis with concomitant gallstones from transductal to transcystic approach.
Collapse
Affiliation(s)
- James O Brewer
- Department of Upper Gastrointestinal Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Lalin Navaratne
- Department of Upper Gastrointestinal Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.,Defence Medical Services, Birmingham, UK
| | | | | | | | | | - Alberto Martínez Isla
- Department of Upper Gastrointestinal Surgery, Northwick Park Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK. .,Department of Surgery and Cancer, Imperial College London, London, UK.
| |
Collapse
|