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Poprom N, Suragul W, Muangkaew P, Vassanasiri W, Rungsakulkij N, Mingphruedhi S, Tangtawee P. Timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in cholelithiasis patients: A systematic review and meta-analysis. Ann Hepatobiliary Pancreat Surg 2023; 27:20-27. [PMID: 36221300 PMCID: PMC9947374 DOI: 10.14701/ahbps.22-040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 02/17/2023] Open
Abstract
There are many variations and unclear definitions of the appropriate timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP), and there is still a lack of consistency about the appropriate timing. Inappropriate timing can be associated with serious comorbidity and can affect the patients. This meta-analysis was conducted to assess the operative outcomes and morbidity to provide a benefit to the patients based on the best timing of LC after ERCP. Randomized controlled trials (RCTs) and retrospective studies were identified from the PubMed and Scopus databases from inception to July 2021. A meta-analysis was performed to estimate the treatment effects on operative outcomes and morbidity. Four RCTs and four retrospective studies met our inclusion criteria. A meta-analysis indicated that patients who received LC after ERCP on the same day or within 72 hours had about 0.354 days shorter length of hospital stay with a shorter operative time of about 0.111-1.835 minutes and a lower risk of complications around 37%-73%. Our evidence suggests that the appropriate timing of LC after ERCP is either the same day or within 72 hours for treating cholelithiasis patients based on the severity of disease.
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Affiliation(s)
- Napaphat Poprom
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wikran Suragul
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paramin Muangkaew
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Watoo Vassanasiri
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narongsak Rungsakulkij
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somkit Mingphruedhi
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsatorn Tangtawee
- Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Division of Hepato-Pancreato Biliary, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,Corresponding author: Pongsatorn Tangtawee, MD Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachatevi, Bangkok 10400, Thailand Tel: +66-2-201-1527, Fax: +66-2-201-1316, E-mail: ORCID: https://orcid.org/0000-0001-9598-5479
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2
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Sewefy AM, Elsageer EM, Kayed T, Mohammed MM, Taha Zaazou MM, Hamza HM. Nasobiliary guided laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography, randomized controlled trial. Surgeon 2022:S1479-666X(22)00101-9. [PMID: 35953433 DOI: 10.1016/j.surge.2022.06.003] [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: 03/03/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is the most common management of gallstones combined with common bile duct (CBD) stones. This study aims to evaluate the impact of routine insertion of nasobiliary catheter during ERCP in cases of difficult LC. PATIENTS & METHODS From total 110 patients who underwent ERCP followed by LC in the period from April 2019 to April 2020, nasobiliary (NB) catheter was inserted during ERCP in 55 patients after CBD clearance (NB group). In the other 55 patients, only CBD clearance was done (Control group). In the NB group, dynamic trans-nasobiliary intraoperative cholangiography (TN-IOC) was done during dissection of Calot's triangle. At the end of the procedure, trans-nasobiliay methylene blue (MB) test was done to detect any missed biliary injury. The primary outcome to be analyzed was the incidence and severity of bile duct injury (BDI), secondary outcomes were the operative time, conversion to open surgery, and hospital stay. RESULTS Of the 110 patients, 57 patients (51.8%) were males and 53 (48.2%) were females. Median age was 55 years. One case of biliary leak was reported in the NB group (1.8%), while 2 cases (3.6%) were reported in the Control group. The average operative time in the NB group was 115 min versus 128 min in the Control group (P value < 0.001). No cases were converted to open cholecystectomy in the NB group (0%) with 5 cases (9.1%) converted to open in the Control group. The average postoperative hospital stay was 2 ± 0.1 days in the NB group versus 3.6 ± 5.3 days in the Control group (P value = 0.037). CONCLUSION Routine insertion of nasobiliary tube during ERCP, in patients with combined gallbladder and CBD stones, is a simple, safe and dynamic method for IOC. This maneuver does not statistically decrease the incidence of BDI but can diagnose, minimize and treat BDI with shorter operative time and hospital stay.
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Affiliation(s)
- Alaa M Sewefy
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | - Emad M Elsageer
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | - Taha Kayed
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt
| | | | - Mohamed M Taha Zaazou
- Department of General Surgery, Faculty of Medicine, Misr University for Science and Technology, Egypt
| | - Hosam M Hamza
- Department of General Surgery, Faculty of Medicine, Minia University, Egypt.
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Tomihara H, Tomimaru Y, Hashimoto K, Fukuchi N, Yokoyama S, Mori T, Tanemura M, Sakai K, Takeda Y, Tsujie M, Yamada T, Miyamoto A, Hashimoto Y, Hatano H, Shimizu J, Sugimoto K, Kashiwazaki M, Matsumoto K, Kobayashi S, Doki Y, Eguchi H. Preoperative risk score to predict subtotal cholecystectomy after gallbladder drainage for acute cholecystitis: Secondary analysis of data from a multi-institutional retrospective study (CSGO-HBP-017B). Asian J Endosc Surg 2022; 15:555-562. [PMID: 35302288 DOI: 10.1111/ases.13051] [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: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Subtotal cholecystectomy (STC) has become recognized as a "bailout procedure" to prevent bile duct injury in patients undergoing laparoscopic cholecystectomy (LC). Predictors of conversion to STC have not been identified because LC difficulty varies based on pericholecystic inflammation. We analyzed data from patients enrolled in a previously performed multi-institutional retrospective study of the optimal timing of LC after gallbladder drainage for acute cholecystitis (AC). These patients presumably had a considerable degree of pericholecystic inflammation. METHODS In total, 347 patients who underwent LC after gallbladder drainage for AC were analyzed to examine preoperative and perioperative factors predicting conversion to STC. RESULTS Three hundred patients underwent total cholecystectomy (TC) and 47 underwent conversion to STC. Eastern Cooperative Oncology Group Performance Status (ECOG PS) (P < .01), severity of cholecystitis (P = .04), previous history of treatment for common bile duct stones (CBDS) (P < .01), and surgeon experience (P = .03) were significantly associated with conversion to STC. Logistic regression analyses showed that ECOG PS (odds ratio 0.2; P < .0001) and previous history of treatment for CBDS (odds ratio 0.37; P = .0073) were independent predictors of conversion to STC. Our predictive risk score using these two variables suggested that a score ≥2 could discriminate between TC and STC (P < .0001). CONCLUSION Poor ECOG PS and previous history of treatment for CBDS were significantly associated with conversion to STC after gallbladder drainage for AC.
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Affiliation(s)
- Hideo Tomihara
- Department of Surgery, Faculty of Medicine, Nara Hospital, Kindai University, Ikoma, Japan.,Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan
| | - Yoshito Tomimaru
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazuhiko Hashimoto
- Department of Surgery, Faculty of Medicine, Nara Hospital, Kindai University, Ikoma, Japan.,Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan
| | - Nariaki Fukuchi
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Shigekazu Yokoyama
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Takuji Mori
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Tane General Hospital, Osaka, Japan
| | - Masahiro Tanemura
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan.,Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Kenji Sakai
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Yutaka Takeda
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Masanori Tsujie
- Department of Surgery, Faculty of Medicine, Nara Hospital, Kindai University, Ikoma, Japan.,Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Terumasa Yamada
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Atsushi Miyamoto
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - Yasuji Hashimoto
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Yao Municipal Hospital, Yao, Japan
| | - Hisanori Hatano
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan.,Department of Surgery, Ashiya Municipal Hospital, Ashiya, Japan
| | - Junzo Shimizu
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan.,Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Keishi Sugimoto
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Minoh City Hospital, Minoh, Japan.,Department of Surgery, Kawanishi City Hospital, Kawanishi, Japan
| | - Masaki Kashiwazaki
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Surgery, Osaka General Medical Center, Osaka, Japan.,Department of Surgery, Otemae Hospital, Osaka, Japan
| | - Kenichi Matsumoto
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shogo Kobayashi
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Eguchi
- Hepato-Biliary-Pancreatic Group, Clinical Study Group of Osaka University, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Gao MJ, Jiang ZL. Effects of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography on liver, bile, and inflammatory indices and cholecysto-choledocholithiasis patient prognoses. Clinics (Sao Paulo) 2021; 76:e2189. [PMID: 33852651 PMCID: PMC8009063 DOI: 10.6061/clinics/2021/e2189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study explored the effects of the timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) on liver function, bile biochemical indices, inflammatory reactions, and cholecysto-choledocholithiasis patient prognoses. METHODS A total of 103 cholecysto-choledocholithiasis patients were stratified into control (CG; n=51; LC at 4-7 d after ERCP) and observation groups (OG; n=52; LC at 1-3 d after ERCP) using a random number table. RESULTS The surgical time was shorter and intraoperative blood loss was less in OG than in CG, and the two groups were not statistically different in terms of time to the first passage of gas through anus, length of postoperative hospital stay, conversion rate to laparotomy, and stone-free rate. Four weeks after LC, alanine aminotransferase (ALT), total bilirubin (TBil), albumin (ALB), and glutamyl transpeptidase (GGT) levels declined in both groups, but the difference was not statistically significant. Three days after LC, total bile acid (TBA) levels increased, and cholesterol (CHO), unconjugated bilirubin (UCB), and TBiL levels were reduced in both groups, but were not statistically different (p>0.05). Three days after LC, interleukin (IL)-6, procalcitonin (PCT), and high-sensitivity C-reactive protein (hs-CRP) levels in the serum and bile increased in both groups and were lower in OG. The total incidence of perioperative complications was 1.92% in OG, which was lower than 15.69% in the CG. CONCLUSION For cholecysto-choledocholithiasis patients, LC at 1-3 d after ERCP can shorten surgical times, reduce intraoperative blood loss, improve liver function and bile biochemistry, relieve inflammatory reactions, reduce complications, and improve prognoses.
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Affiliation(s)
- Ming-Jun Gao
- Department of Gastroenterology, Taizhou People’s Hospital, Taizhou City, Jiangsu Province, China
| | - Zhi-Lan Jiang
- Department of Immunization Program, Center for Disease Control and Prevention of Hailing District, Taizhou City, Jiangsu Province, China
- *Corresponding author. E-mail:
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Bergeron E, Desilets E, Maniere T, Bensoussan M. Same-day endoscopic ultrasound, retrograde cholangiopancreatography and stone extraction, followed by cholecystectomy: A case report and literature review. Int J Surg Case Rep 2020; 70:115-118. [PMID: 32416480 PMCID: PMC7229231 DOI: 10.1016/j.ijscr.2020.04.063] [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: 02/26/2020] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 12/07/2022] Open
Abstract
The risk of recurrence or complications is high after a common bile duct stone related event. Cholecystectomy should be carried out soon after extraction of a common bile duct stone. Same-day investigation, endoscopic stone extraction and cholecystectomy is feasible and safe.
Introduction Common bile duct stone-related events and their recurrence are frequent even after endoscopic retrograde cholangiopancreatography and stone extraction. Cholecystectomy should be carried out as soon as possible after the initial episode to prevent complications. Case presentation We present a case of a patient who underwent endoscopic ultrasound, cholangiopancreatography with stone extraction and cholecystectomy on the same day. Discussion After a common bile duct stone-related event, investigation, and stone extraction, cholecystectomy should be carried out as soon as possible to avoid high rates of recurrence and complications. Rise in health care costs nowadays mandate such an approach as a pre-emptive measure to prevent health complications while lowering health costs. Conclusion Diagnosis of common bile duct stone followed by extraction with endoscopic cholangiopancreatography and cholecystectomy on the same day is feasible, safe, and has many potential advantages.
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Affiliation(s)
- Eric Bergeron
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada.
| | - Etienne Desilets
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Thibaut Maniere
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
| | - Michael Bensoussan
- Departments of Surgery and Gastroenterology, Charles-LeMoyne Hospital, Greenfield Park, Canada
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