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Capparelli MA, Cotignola L, Domínguez MV, D'Alessandro PD, Ayarzabal VH, Barrenechea ME. Clinical Utility of Definitive Diagnostic Tests for Choledocholithiasis in Pediatric Patients with Mild Gallstone Pancreatitis. J Pediatr Surg 2023; 58:2352-2355. [PMID: 37460346 DOI: 10.1016/j.jpedsurg.2023.06.011] [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: 05/01/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Gallstone pancreatitis was historically considered a risk factor for choledocholithiasis (CD). However, recent studies of adult patients evidenced a weak association between gallstone pancreatitis and CD. The aim of this study was to analyze this association in pediatric patients. METHODS We conducted a retrospective study on patients with mild gallstone pancreatitis who underwent any definitive testing for CD (MRCP, ERCP, IOC), managed between March 2010 and September 2022. Patients were classified according to the presence or absence of risk factors for CD (total bilirubin ≥2 mg/dl; common bile duct >6 mm on ultrasound; and/or CD on ultrasound). We evaluated the diagnosis of CD on definitive testing in both groups and analyzed the predictive capacity of the presence of risk factors. RESULTS Eighty-four patients were included in the final analysis. Seventy-nine percent were females. The median age was 13 (4-17) years. Forty-seven (55.9%) patients had one or more risk factors. The definitive testing confirmed 13 (15.5%) cases of CD, 12 (25.5%) in the group of patients with risk factors and 1 (2.7%) in those without risk factors. The sensitivity, specificity, positive predictive value and negative predictive value of the presence of associated risk factors were 92.3, 50.7, 25.5 and 97.3%, respectively. CONCLUSION Pediatric patients with gallstone pancreatitis without associated risk factors have a very low incidence of CD. In these patients we suggest performing a laparoscopic cholecystectomy without intraoperative cholangiography or any other definitive test for CD. LEVEL OF EVIDENCE Level II, retrospective study.
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Affiliation(s)
| | - Luciana Cotignola
- Division of General Surgery, J.P. Garrahan Hospital, Buenos Aires, Argentina
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2
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Huang H, Du D, Wang Z, Xie Y, Ni Z, Li X, Jin H. Application of Intraoperative Fluorescence Imaging with Indocyanine Green in the Difficult Gallbladder: A Comparative Study between Indocyanine Green-Guided Fluorescence Cholangiography and Conventional Surgery. J Laparoendosc Adv Surg Tech A 2022; 33:404-410. [PMID: 36577039 DOI: 10.1089/lap.2022.0467] [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: 12/29/2022] Open
Abstract
Background: In the difficult gallbladder, the rate of bile duct injury (BDI) remains high. To lessen iatrogenic biliary injury, we attempted to utilize indocyanine green (ICG)-guided fluorescence cholangiography during surgery to illuminate the extrahepatic biliary tract. Materials and Methods: According to admission criteria, 38 patients were diagnosed with difficult gallbladder and underwent percutaneous transhepatic gallbladder drainage (PTGBD). Consecutive patients who underwent ICG-assisted laparoscopic biliary surgery (n = 18, ICG group) or conventional laparoscopic biliary surgery (n = 20, white light [WL group) were enrolled in this study. ICG group received ICG fluorescent cholangiography via PTGBD tube during operation; 16 cases of laparoscopic cholecystectomy (LC) and 2 cases of LC plus laparoscopic common bile duct exploration (LC+LCBDE) were performed by fluorescent laparoscopy. In the WL group, 16 cases of LC, 1 case of laparoscopic subtotal cholecystectomy (LSC), and 3 cases of LC+LCBDE were performed under white light without ICG. Result: The biliary system was successfully established in the ICG group. Compared with the WL group, the anatomy of the Calot's triangle with severe abdominal adhesion or local inflammatory edema was more clearly displayed by fluorescence. Laparoscopic surgery was completed in both groups without conversion to laparotomy. There were no significant differences in surgery-related complications (P = .232) and postoperative hospital stay (P = .074) between the two groups. However, compared with the WL group, the ICG group had less intraoperative blood loss (P = .002) and shorter operation duration (P = .006). Conclusion: ICG fluorescence cholangiography has good clinical application value in the difficult gallbladder, which can avoid iatrogenic BDI, reduce surgery-related complications and intraoperative blood loss, and shorten the duration of surgery.
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Affiliation(s)
- Hai Huang
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Danwei Du
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Ziqiang Wang
- Department of Breast Armor Surgery, the First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Yangyang Xie
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Zhongkai Ni
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Xiaowen Li
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
| | - Haimin Jin
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, affiliated to Zhejiang Chinese Medicine University, Hangzhou, China
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3
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Kovács N, Németh D, Földi M, Nagy B, Bunduc S, Hegyi P, Bajor J, Müller KE, Vincze Á, Erőss B, Ábrahám S. Selective intraoperative cholangiography should be considered over routine intraoperative cholangiography during cholecystectomy: a systematic review and meta-analysis. Surg Endosc 2022; 36:7126-7139. [PMID: 35794500 PMCID: PMC9485186 DOI: 10.1007/s00464-022-09267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
Abstract
Background Decades of debate surround the use of intraoperative cholangiography (IOC) during cholecystectomy. To the present day, the role of IOC is controversial as regards decreasing the rate of bile duct injury (BDI). We aimed to review and analyse the available literature on the benefits of IOC during cholecystectomy. Methods A systematic literature search was performed until 19 October 2020 in five databases using the following search keys: cholangiogra* and cholecystectomy. The primary outcomes were BDI and retained stone rate. To investigate the differences between the groups (routine IOC vs selective IOC and IOC vs no IOC), we calculated weighted mean differences (WMD) for continuous outcomes and relative risks (RR) for dichotomous outcomes, with 95% confidence intervals (CI). Results Of the 19,863 articles, 38 were selected and 32 were included in the quantitative synthesis. Routine IOC showed no superiority compared to selective IOC in decreasing BDI (RR = 0.91, 95% CI 0.66; 1.24). Comparing IOC and no IOC, no statistically significant differences were found in the case of BDI, retained stone rate, readmission rate, and length of hospital stay. We found an increased risk of conversion rate to open surgery in the no IOC group (RR = 0.64, CI 0.51; 0.78). The operation time was significantly longer in the IOC group compared to the no IOC group (WMD = 11.25 min, 95% CI 6.57; 15.93). Conclusion Our findings suggest that IOC may not be indicated in every case, however, the evidence is very uncertain. Further good quality research is required to address this question. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09267-x.
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Affiliation(s)
- Norbert Kovács
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Institute of Bioanalysis, University of Pécs Medical School, Pécs, Hungary
| | - Mária Földi
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.,Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bernadette Nagy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Stefania Bunduc
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Gastroenterology, Hepatology and Liver Transplant Department, Fundeni Clinical Institute, Bucharest, Romania.,Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Bajor
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Eszter Müller
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, University of Pécs Medical School, Pécs, Hungary.,Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, Szent-Györgyi Albert Medical and Pharmaceutical Centre, University of Szeged, Semmelweis u. 8, 6720, Szeged, Hungary.
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4
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Wang C, Peng W, Yang J, Li Y, Yang J, Hu X, Xia L, Zhang L, Zhong Y, Qiao L, Pan W. Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy. J Int Med Res 2021; 48:300060520979224. [PMID: 33334212 PMCID: PMC7750833 DOI: 10.1177/0300060520979224] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Near-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy. METHODS Consecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed. RESULTS Laparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m2. CONCLUSIONS NIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.
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Affiliation(s)
- Chusi Wang
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenguang Peng
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiarui Yang
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuxuan Li
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiawei Yang
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xueqiao Hu
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Xia
- Department of Hepatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuesi Zhong
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Qiao
- Storr Liver Centre, Westmead Institute for Medical Research, University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Weidong Pan
- Department of Biliary-Pancreatic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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5
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Werenski HE, Bosley ME, Powell MS, Meredith JW, Randle RW. Outcomes Following Cholecystectomy on a Service Designed to Maximize Chief Resident Entrustment. J Surg Res 2021; 264:474-480. [PMID: 33857791 DOI: 10.1016/j.jss.2021.02.042] [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: 12/01/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The chief resident service provides surgical trainees in their final year of training the opportunity to maximize responsibility, continuity, and decision-making. Although supervised, chief residents operate according to personal preferences instead of adapting to their attendings' preferences. We hypothesized that outcomes following cholecystectomy are equivalent between the chief resident service and standard academic services. METHODS We matched adults undergoing cholecystectomy from 07/2016-06/2019 on the chief resident service to two standard academic service patients based on operative indication and age. We compared demographics, operative details, and 30-d complications. RESULTS This study included 186 patients undergoing cholecystectomy. Body mass index (32.4 versus 32.0, P = 0.49) and Charlson comorbidity index (0.9 versus 1.4, P = 0.16) were similar between chief resident and standard academic services, respectively. Operative approach was similar (95.2% laparoscopic on chief resident service versus 94.4% on standard service), but residents on the chief resident service performed cholangiograms more often (48.4% versus 22.6%, P < 0.01) and averaged longer operative times during laparoscopic cholecystectomy with cholangiogram (146±28 versus 85±22 min, P < 0.01) and without (94±31 versus 76±35 min, P < 0.01) compared with standard academic services, respectively. 30-d complication rates were similar (5.2% chief resident versus 5.0% standard, P = 0.95). No patients suffered bile leak, bile duct injury, or reoperation. Emergency Department visits were similar (12.1% chief resident versus 7.4% standard, P = 0.32); readmissions were less frequent on the chief resident service (0.0% versus 5.0% standard, P = 0.03). CONCLUSIONS With appropriate supervision, chief residents provide safe care for patients undergoing cholecystectomy while directing medical decisions and practicing according to their preferences.
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Affiliation(s)
- Hope E Werenski
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Maggie E Bosley
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Myron S Powell
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - J Wayne Meredith
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Reese W Randle
- Department of Surgery, Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, NC.
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6
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Donnellan E, Coulter J, Mathew C, Choynowski M, Flanagan L, Bucholc M, Johnston A, Sugrue M. A meta-analysis of the use of intraoperative cholangiography; time to revisit our approach to cholecystectomy? Surg Open Sci 2021; 3:8-15. [PMID: 33937738 PMCID: PMC8076912 DOI: 10.1016/j.sopen.2020.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete. METHODS An International Prospective Register of Systematic Reviews-registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy "intraoperative AND cholangiogra* AND cholecystectomy." Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. A dichotomous random effects meta-analysis using the Mantel-Haenszel method performed on Review Manager Version 5.3 was carried out. RESULTS Of 2,059 articles reviewed, 62 met criteria for final analysis. The mean rate of intraoperative cholangiography was 38.8% (range 1.6%-96.4%).There was greater detection of bile duct stones during cholecystectomy with routine intraoperative cholangiography compared with selective intraoperative cholangiography (odds ratio = 3.28, confidence interval = 2.80-3.86, P value < .001). While bile duct injury during cholecystectomy was less with intraoperative cholangiography (0.39%) than without intraoperative cholangiography (0.43%), it was not statistically significant (odds ratio = 0.88, confidence interval = 0.65-1.19, P value = .41). Readmission following cholecystectomy with intraoperative cholangiography was 3.0% compared to 3.5% without intraoperative cholangiography (odds ratio = 0.91, confidence interval = 0.78-1.06, P value = .23). CONCLUSION The use of intraoperative cholangiography still has its place in cholecystectomy based on the detection of choledocholithiasis and the potential reduction of unfavorable outcomes associated with common bile duct stones. This meta-analysis, the first to review intraoperative cholangiography use, identified a marked variation in cholangiography use. Retrospective studies limit the ability to critically define association between intraoperative cholangiography use and bile duct injury.
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Affiliation(s)
- Eoin Donnellan
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Jonathan Coulter
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland
| | - Cherian Mathew
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Michelle Choynowski
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
| | - Louise Flanagan
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Londonderry, Northern Ireland
| | - Alison Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, County Donegal, Ireland
- EU INTERREG Emergency Surgery Outcome Advancement Project, Centre for Personalised Medicine, Letterkenny, Ireland
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Abstract
Acute biliary disease is a ubiquitous acute surgical complaint. General surgeons managing emergency surgical patients must be knowledgeable and capable of identifying and caring for common presentations. This article discusses the work-up, diagnosis, and management of the varying pathologies that make up biliary disease including cholelithiasis, cholecystitis, biliary dyskinesia, choledocholithiasis, cholangitis, gallstone pancreatitis, and gallstone ileus. Also addressed are more challenging and rare presentations including pregnancy and bariatric anatomy.
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Affiliation(s)
- Ann Yih-Ann Chung
- Department of Surgery, University of North Carolina-Chapel Hill, 4035 Burnett-Womack, Campus Box 7081, Chapel Hill, NC 27599-7081, USA.
| | - Meredith Colleen Duke
- Department of Surgery, University of North Carolina-Chapel Hill, 4035 Burnett-Womack, Campus Box 7081, Chapel Hill, NC 27599-7081, USA
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8
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Martin B, Ong EGP. Selective intraoperative cholangiography during laparoscopic cholecystectomy in children is justified. J Pediatr Surg 2018; 53:270-273. [PMID: 29229482 DOI: 10.1016/j.jpedsurg.2017.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
AIMS Intraoperative cholangiograms (IOC) during laparoscopic cholecystectomy have been advocated to detect biliary anomalies and intraductal calculi. However, IOC increases operative time and patient irradiation, and therefore is not universally used. We hypothesise selective IOC may be a valuable tool in children. METHODS A retrospective case note review was performed of all children who underwent laparoscopic cholecystectomy at a single institution by a single surgeon between January 2011 and March 2017. Demographics, radiological imaging, indications for surgery and IOC, and clinical outcomes were collected. Chi-Squared and Wilcoxon Rank Sum tests were used for comparisons. RESULTS Sixty-two patients were reviewed. Median follow-up was 2 months (0.1-60), and 53 (85%) had complete symptom resolution following surgery. Twenty-two patients underwent IOC. Six (27%) had anomalies undetected by preoperative imaging. IOC identified common bile duct (CBD) stones in 2 patients which were cleared at laparoscopy. One patient required subsequent ERCP for impacted stones. One patient has a long common channel and pancreatitis. Two patients have CBD strictures. These last 3 are awaiting biliary reconstruction. Presence of CBD dilatation or ductal stones on preoperative ultrasound were significantly associated with positive findings at IOC. No complications resulted from IOC. Patients who did not undergo IOC did not represent with missed anomalies. CONCLUSIONS Despite using multimodal preoperative imaging, IOC detected biliary anomalies requiring further treatment in 6/62 (10%) of patients undergoing laparoscopic cholecystectomy. Our data support the use of IOC in selective patients with CBD dilatation or suspicion of ductal stones on preoperative imaging. LEVEL OF EVIDENCE Study of Diagnostic Test: Level III.
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Affiliation(s)
- Benjamin Martin
- The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
| | - Evelyn Geok Peng Ong
- The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
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9
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Population-Based Studies Should not be Used to Justify a Policy of Routine Cholangiography to Prevent Major Bile Duct Injury During Laparoscopic Cholecystectomy. World J Surg 2017; 41:82-89. [PMID: 27468742 DOI: 10.1007/s00268-016-3665-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Iatrogenic bile duct injury at time of cholecystectomy is a rare but devastating event. A twofold higher frequency of bile duct injury during cholecystectomy without cholangiography is reported in population-based studies. Some interpret this as a cause-and-effect relationship and thus mandate routine cholangiography. A critical appraisal of population studies is required to determine whether these studies are suitable in determining the role of routine cholangiography. The literature search was performed using combinations of the forced search terms "duct injury", "population" and "cholangiography" to identify population-based studies assessing the relationship between cholangiography and iatrogenic bile duct injury. All seven population-based studies reported a numerically higher rate of bile duct injury when an intraoperative cholangiogram was not obtained during cholecystectomy. Five predate the critical view technique. Only one was limited to laparoscopic cholecystectomy. All studies identified cholangiography as a likely marker for disease severity or surgical technique. Six studies did not demonstrate a cause-and-effect relationship by not including effect modifiers. The only study to address confounders reported the same rate of injury irrespective of the use of cholangiography. Critical appraisal of population-based studies does not support their use in justifying a policy of routine cholangiography to prevent major bile duct injury.
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10
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Abdelaal A, El-Matbouly M, Sulieman I, Elfaki A, El-Bakary T, Abdelaziem S, Gehani S, Toro A, Di Carlo I. Role of intraoperative cholangiography for detecting residual stones after biliary pancreatitis: still useful? A retrospective study. World J Emerg Surg 2017; 12:18. [PMID: 28428811 PMCID: PMC5397714 DOI: 10.1186/s13017-017-0130-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/13/2017] [Indexed: 12/30/2022] Open
Abstract
Background Intraoperative cholangiography (IOC) may detect residual stones in the common bile duct (CBD) after acute biliary pancreatitis (ABP). The aim of the present study is to analyze the utility of IOC in detecting residual stones in patients undergoing cholecystectomy for ABP and if complications are related with this procedure. Methods Demographic and clinical factors were assessed in patients with mild ABP who underwent IOC during laparoscopic cholecystectomy. Factors assessed included preoperative size of the CBD on ultrasonography, presence of stones in the gallbladder and the CBD, and IOC results. For the statistical analysis, χ2 or Fisher’s exact tests to compare proportions and the nonparametric Mann–Whitney U test for analysis of values with abnormal distribution were used. Results The study included 113 patients, 82 males (72.6%) and 31 females (27.4%), of mean age 46.9 ± 14.7 years (range 18–86 years). All preoperative laboratory indicators were elevated. The group of the patients with stones in the CBD diagnosed by IOC was divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD diagnosed preoperatively with ultrasound. The laboratory tests do not demonstrate difference statistically significative between these two groups. The group of the patients without stones in the CBD diagnosed by IOC was also divided in patients with diameters <0.8 mm and with diameters ≥0.8 mm of the CBD. Also in these two groups, the statistical analysis of the laboratory tests does not demonstrate significative difference. Most procedures were performed by specialists (64.6%), and all patients underwent IOC. IOC showed stones in 84/113 patients (74.3%). A comparison of patients with and without stones at IOC showed similar mean times from hospitalization to surgery (5.9 days [range 2–12 days] vs. 6.1 days [range 2–23 days]), from surgery until hospital discharge (2.0 days [range 0–4 days] vs. 2.2 days [range 0–11 days]), and overall length of stay (7.9 days [range 3–19 days] vs. 8.3 days [range 3–23 days]) (P > 0.001). Conclusions IOC is useful to diagnose residual CBD stones, without increasing complications related to the procedure itself.
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Affiliation(s)
- Abdelrahman Abdelaal
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Moamena El-Matbouly
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Ibnouf Sulieman
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Ahmad Elfaki
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Tamer El-Bakary
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Sherif Abdelaziem
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Salahdin Gehani
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Adriana Toro
- Department of Surgery, Barone Romeo Hospital, via Mazzini 14, 98066 Patti, (ME) Italy
| | - Isidoro Di Carlo
- Department of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar.,Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
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11
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Ankersmit M, van Dam DA, van Rijswijk AS, van den Heuvel B, Tuynman JB, Meijerink WJHJ. Fluorescent Imaging With Indocyanine Green During Laparoscopic Cholecystectomy in Patients at Increased Risk of Bile Duct Injury. Surg Innov 2017; 24:245-252. [PMID: 28178882 PMCID: PMC5431362 DOI: 10.1177/1553350617690309] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although rare, injury to the common bile duct (CBD) during laparoscopic cholecystectomy (LC) can be reduced by better intraoperative visualization of the cystic duct (CD) and CBD. The aim of this study was to establish the efficacy of early visualization of the CD and the added value of CBD identification, using near-infrared (NIR) light and the fluorescent agent indocyanine green (ICG), in patients at increased risk of bile duct injury. MATERIALS AND METHODS Patients diagnosed with complicated cholecystitis and scheduled for LC were included. The CBD and CD were visualized with NIR light before and during dissection of the liver hilus and at critical view of safety (CVS). RESULTS Of the 20 patients originally included, 2 were later excluded due to conversion. In 6 of 18 patients, the CD was visualized early during dissection and prior to imaging with conventional white light. The CBD was additionally visualized with ICG-NIR in 7 of 18 patients. In 1 patient, conversion was prevented due to detection of the CD and CBD with ICG-NIR. CONCLUSIONS Early visualization of the CD or additional identification of the CBD using ICG-NIR in patients with complicated cholecystolithiasis can be helpful in preventing CBD injury. Future studies should attempt to establish the optimal dosage and time frame for ICG administration and bile duct visualization with respect to different gallbladder pathologies.
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Niu X, Song J, He X, Chen J, Xu J, Li Z, Long H, Wei J. Micro-Incision of the Cystic Duct Confluence in Laparoscopic Common Bile Duct Exploration for Elderly Patients with Choledocholithiasis. Indian J Surg 2016; 80:227-232. [PMID: 29973752 DOI: 10.1007/s12262-016-1574-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 12/16/2016] [Indexed: 01/17/2023] Open
Abstract
Common bile duct (CBD) stones are common in elderly patients. The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach. Its safety and efficacy have not been studied in elderly patients with secondary choledocholithiasis. This study evaluates the safety and efficacy of LTM-CBDE in elderly (≥65 years) patients with secondary choledocholithiasis and compares the results with those in younger patients. In this retrospective analysis, 128 patients underwent LTM-CBDE from March 2007 to December 2013. The patients were divided into two groups according to age: the elderly group consisted of 50 patients aged ≥65 years and the younger group consisted of 78 patients aged <65 years. The preoperative morbidity rate, American Society of Anesthesiologists (ASA) score, previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality were compared in both groups. The preoperative morbidity (41 vs. 28) and ASA score (2.5 ± 0.7 vs. 1.8 ± 0.6) were higher in the elderly group (P = 0.000, in both groups). No significant differences in previous abdominal operations, operation time, postoperative hospital stay, open conversion rate, postoperative complication rate, residual stone rate, recurrence rate and mortality (P > 0.05) were found between the two groups from March 2007 to December 2013. LTM-CBDE is a safe and effective treatment procedure for elderly patients with secondary choledocholithiasis. For suitable patients, we recommend LTM-CBDE as the treatment of choice.
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Affiliation(s)
- Xiaojuan Niu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Jinghai Song
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Xiuwen He
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Jian Chen
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Jingyong Xu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Zhe Li
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Haikong Long
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, China, No.1, Dahua Road, Dong Dan, Dongcheng District, Beijing, 100730 China
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Tokumura H, Iida A, Sasaki A, Nakamura Y, Yasuda I. Gastroenterological surgery: The gallbladder and common bile duct. Asian J Endosc Surg 2016; 9:237-249. [PMID: 27790872 DOI: 10.1111/ases.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hiromi Tokumura
- Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan.
| | - Atsushi Iida
- First Department of Surgery, University of Fukui, Fukui, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Jeremić-Savić L, Radojković M, Aranđelovć S. PARAMETERS FOR SELECTIVE INTRAOPERATIVE CHOLANGIOGRAPHY IN THE DIAGNOSIS OF COMMON BILE DUCT STONES. ACTA MEDICA MEDIANAE 2015. [DOI: 10.5633/amm.2015.0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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van Dam DA, Ankersmit M, van de Ven P, van Rijswijk AS, Tuynman JB, Meijerink WJHJ. Comparing Near-Infrared Imaging with Indocyanine Green to Conventional Imaging During Laparoscopic Cholecystectomy: A Prospective Crossover Study. J Laparoendosc Adv Surg Tech A 2015; 25:486-92. [PMID: 25974072 DOI: 10.1089/lap.2014.0248] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to test and validate a novel noninvasive method for intraoperative visualization of extrahepatic bile ducts during laparoscopic cholecystectomy. Injury to the common bile duct (CBD) is a rare but major complication of laparoscopic cholecystectomy. Most injuries occur when anatomy is unclear due to the presence of anatomic variations, acute inflammation, or adhesions. PATIENTS AND METHODS Thirty patients were included, and each received an intravenous injection of 0.05 mg/kg of indocyanine green (ICG) (ICG-Pulsion(®); PULSION Medical Systems AG, Munich, Germany) prior to the start of surgery. Laparoscopic cholecystectomy was performed according to standard procedures. The CBD and cystic duct (CD) were visualized before and during dissection of the liver hilus using a conventional laparoscopic camera and a recently developed near-infrared (NIR) camera (Olympus, Tokyo, Japan). RESULTS Using ICG-NIR, the CBD and CD could be visualized 11 minutes (P=.008) and 8.6 minutes (P=.001) earlier than with a conventional camera. Both early (20/30 patients) and late (26/30 patients) identification of the CBD with ICG-NIR was significantly more frequent compared with conventional images (2/30 and 10/30, respectively; P<.001). One postoperative bilioma required re-admission and endoscopic retrograde cholangiopancreatography with stent placement. CONCLUSIONS Identification of the CBD and CD using a low dose of ICG and the NIR camera was both faster and more frequent compared with conventional laparoscopic images during elective laparoscopic cholecystectomy.
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Affiliation(s)
- Dieuwertje A van Dam
- 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands
| | - Marjolein Ankersmit
- 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands
| | - Peter van de Ven
- 2 Department of Epidemiology, VU University Medical Centre , Amsterdam, The Netherlands
| | | | - Jurriaan B Tuynman
- 1 Department of Surgery, VU University Medical Centre , Amsterdam, The Netherlands
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Abstract
OBJECTIVES The aim of this study was to develop and compare the predictive accuracy of classification and regression tree (CART) analysis with logistic regression (LR) for predicting common bile duct stones (CBDS) in patients subjected to laparoscopic cholecystectomy. PATIENTS AND METHODS We prospectively collected preoperative (demographic, biochemical, ultrasonographic) and intraoperative (intraoperative cholangiography, cystic duct diameter) data for 154 patients considered for elective laparoscopic cholecystectomy at the department of General Surgery at Gornji Milanovac from 2013 through 2014. Univariate and multivariate regression analyses were used to determine independent predictors of CBDS. The CART analysis was carried out using the predictors identified by LR analysis. Various measures for the assessment of risk prediction models were determined, such as predictive ability, accuracy, the area under the receiver operating characteristic curve, and clinical utility using decision curve analysis. RESULTS The most decisive variable at the time of classification was the cystic duct diameter category, the alkaline phosphatase, and dangerous stones. The CART model was shown to have good discriminatory ability (93.9%). Accuracy was similar in both models, ranging from 92.9% in the CART model and 93.5% in the LR model. In decision curve analysis, the CART model outperformed the LR model. CONCLUSION We developed a user-friendly risk model that can successfully predict the presence of choledocholithiasis in patients planned for elective cholecystectomy. However, before recommending its use in clinical practice, a larger and more complete database should be used to further clarify the differences between models in terms of prediction of the CBDS.
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Laparoscopic ultrasound for the diagnosis of choledocholithiasis: quick, safe, and effective. Surg Laparosc Endosc Percutan Tech 2015; 24:274-6. [PMID: 24710230 DOI: 10.1097/sle.0b013e31828fa907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Visualization of the common bile duct during laparoscopic cholecystectomy is frequently required to confirm or exclude choledocholithiasis. Although on-table cholangiogram (OTC) is the traditional imaging technique, laparoscopic ultrasound (LUS) is increasingly deployed for this purpose. We are reporting a 31-month experience with an LUS, starting from the initial set up of the equipment. We retrospectively studied 70 patients who underwent LUS during their laparoscopic cholecystectomy operation over a period of 31 months. Data about preoperative investigation, intraoperative findings, and postoperative outcome were retrospectively collected and analyzed. LUS was found to be quick, safe, and effective in the intraoperative diagnosis of the common bile duct stones. It does not add significantly to the operative time and is inherently safer than intraoperative cholangiogram owing to the fact that it does not involve ionizing radiation. It is also more convenient, as there is no need to wear protective lead to avoid the side effects of ionizing radiation.
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Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study. Surg Endosc 2014; 29:2033-8. [DOI: 10.1007/s00464-014-3907-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/16/2014] [Indexed: 12/15/2022]
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de Aguilar-Nascimento JE, Leal FS, Dantas DCS, Anabuki NT, de Souza AMC, Silva e Lima VP, Tanajura GH, Canevari M. Preoperative Education in Cholecystectomy in the Context of a Multimodal Protocol of Perioperative Care: A Randomized, Controlled Trial. World J Surg 2013; 38:357-62. [DOI: 10.1007/s00268-013-2255-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Tabone LE, Conlon M, Fernando E, Yi S, Sarker S, Fisichella PM, Luchette FA. A practical cost-effective management strategy for gallstone pancreatitis. Am J Surg 2013; 206:472-7. [DOI: 10.1016/j.amjsurg.2012.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 11/22/2012] [Accepted: 12/27/2012] [Indexed: 01/31/2023]
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21
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Ragulin-Coyne E, Witkowski ER, Chau Z, Chau S, Santry HP, Callery MP, Shah SA, Tseng JF. Is routine intraoperative cholangiogram necessary in the twenty-first century? A national view. J Gastrointest Surg 2013; 17:434-42. [PMID: 23292460 PMCID: PMC4570242 DOI: 10.1007/s11605-012-2119-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 12/03/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Intraoperative cholangiogram (IOC) can define biliary ductal anatomy. Routine IOC has been proposed previously. However, current surgeon IOC utilization practice patterns and outcomes are unclear. METHODS Nationwide Inpatient Sample 2004-2009 was queried for patients with acute biliary disease undergoing cholecystectomy (CCY). Analyses only included surgeons performing ≥10 CCY/year. We dichotomized surgeons into a routine IOC group vs. selective. Outcomes included bile duct injury, complications, mortality, length of stay, and cost. RESULTS Of the nonweighted patients, 111,815 underwent CCY. A total of 4,740 actual surgeon yearly volumes were examined. On average, each surgeon performed 23.6 CCYs and 7.9 IOCs annually, using IOC in 33 % of cases. The routine IOC group used IOC for 96 % of cases, whereas selective IOC group used IOC ∼25 % of the time. Routine IOC surgeons had no difference in mortality (0.4 %) or rate of bile duct injury (0.25 vs. 0.26 %), but higher overall complications (7.3 vs. 6.8 %, p = 0.04). Patients of routine IOC surgeons received more additional procedures and incurred higher costs. CONCLUSION Routine IOC does not decrease the rate of bile duct injury, but is associated with significant added cost. Surgeons' routine use of IOC is correlated with increased rates of postsurgical procedures, and is associated with increased overall complications. These data suggest routine IOC may not improve outcomes.
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Affiliation(s)
- Elizaveta Ragulin-Coyne
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Elan R. Witkowski
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Zeling Chau
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Sing Chau
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Heena P. Santry
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Mark P. Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Stoneman 9, Boston, MA 02215, USA
| | - Shimul A. Shah
- Department of Surgery, Surgical Outcomes Analysis & Research (SOAR), University of Massachusetts Medical School, Room S3-752, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Jennifer F. Tseng
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Stoneman 9, Boston, MA 02215, USA
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Jones M, Johnson M, Samourjian E, Schlauch K, Ozobia N. ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure. Surg Endosc 2012; 27:1907-12. [PMID: 23239300 DOI: 10.1007/s00464-012-2647-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/10/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Current treatment of complicated calculous biliary disease typically involves a two-step procedure consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Alternatively, laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and intraoperative common bile duct exploration or ERCP at a later date may be performed. This study compared the benefits of the traditional two-step procedure to the novel one-step procedure for the management of calculous biliary disease. METHODS A retrospective review of 20 patients was conducted comparing one-step to two-step procedures for the management of choledocholithiasis. We define the one-step procedure to be a laparoscopic cholecystectomy with IOC to confirm the presence or absence of stones. Intraoperative ERCP with stone extraction was conducted if necessary as part of the one-step procedure. RESULTS A statistically significant difference existed between hospital charges for one-step ($58,145.30, SD $17,963.09) and two-step ($78,895.53, SD $21,954.78) procedures (p = 0.033). Other parameters (length of stay, preoperative days) trended toward significance; however, statistical significance was not achieved. CONCLUSIONS There appears to be a significant cost reduction with implementation of the one-step treatment of calculous biliary disease. Further research with a larger study population is necessary to determine the additional benefits of this procedure and to help augment the surgical endoscopists' armamentarium.
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Affiliation(s)
- Maris Jones
- Department of Surgery, University of Nevada School of Medicine, 2040 W Charleston Blvd Suite 301, Las Vegas, NV 89102, USA.
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Chennat J. Indications for endoscopic retrograde cholangiopancreatography. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Harsányi L, Hahn O. [Gallbladder surgery]. Magy Seb 2012; 65:150-3. [PMID: 22717969 DOI: 10.1556/maseb.65.2012.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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