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Li Z, Xu D, Yu H, Jiang H, Jin J. Meta-analysis of the timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in patients with cholecystolithiasis and choledocholithiasis. Eur J Gastroenterol Hepatol 2023; 35:619-628. [PMID: 37115972 DOI: 10.1097/meg.0000000000002553] [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] [Indexed: 04/30/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy plays an important role in the treatment of cholecystolithiasis combined with choledocholithiasis; however, there is no unified standard for the interval of ERCP before laparoscopic cholecystectomy. We conducted a literature search, data extraction and meta-analysis on this topic. Twelve articles with 1142 patients were included, including 567 patients in the E-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed within 72 h after ERCP) and 575 patients in the D-laparoscopic cholecystectomy group (laparoscopic cholecystectomy performed 72 h after ERCP). The results showed that: compared with the D-laparoscopic cholecystectomy group, the duration of cholecystectomy was shorter in the E-laparoscopic cholecystectomy group [weighted mean difference (WMD) = -16.18, 95% confidence interval (CI) (-22.27 to -10.08), P < 0.00001], and the postoperative hospitalization was shorter [WMD = -1.24, 95% CI (-1.98 to -0.50), P < 0.0001]. There were fewer complications [odds ratio (OR) = 0.25, 95% CI (0.39-0.62), P < 0.0001], lower conversion rate [OR = 0.39, 95% CI (0.21-0.71), P = 0.002], lower high sensitivity C-reactive protein at 3 days after surgery [WMD = -8.76, 95% CI (-12.59 to -4.93), P < 0.00001], and fewer neutrophils in the ampulla of gallbladder specimen [WMD = -4.21, 95% CI (-4.55 to -3.88), P < 0.00001]. Therefore, in the treatment of cholecystolithiasis combined with choledocholithiasis by laparoscopic cholecystectomy within 72 h after ERCP, the degree of inflammation before and after surgery is less, the operation time and hospital stay are shortened, the postoperative complications and the conversion rate are reduced, which is a more appropriate time for surgery.
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Affiliation(s)
- Zhan Li
- Department of Gastrointestinal Surgery, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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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.
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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
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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.
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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.
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Kuzman M, Bhatti KM, Omar I, Khalil H, Yang W, Thambi P, Helmy N, Botros A, Kidd T, McKay S, Awan A, Taylor M, Mahawar K. Solve study: a study to capture global variations in practices concerning laparoscopic cholecystectomy. Surg Endosc 2022; 36:9032-9045. [PMID: 35680667 DOI: 10.1007/s00464-022-09367-8] [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: 12/13/2021] [Accepted: 05/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is a lack of published data on variations in practices concerning laparoscopic cholecystectomy. The purpose of this study was to capture variations in practices on a range of preoperative, perioperative, and postoperative aspects of this procedure. METHODS A 45-item electronic survey was designed to capture global variations in practices concerning laparoscopic cholecystectomy, and disseminated through professional surgical and training organisations and social media. RESULTS 638 surgeons from 70 countries completed the survey. Pre-operatively only 5.6% routinely perform an endoscopy to rule out peptic ulcer disease. In the presence of preoperatively diagnosed common bile duct (CBD) stones, 85.4% (n = 545) of the surgeons would recommend an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) before surgery, while only 10.8% (n = 69) of the surgeons would perform a CBD exploration with cholecystectomy. In patients presenting with gallstone pancreatitis, 61.2% (n = 389) of the surgeons perform cholecystectomy during the same admission once pancreatitis has settled down. Approximately, 57% (n = 363) would always administer prophylactic antibiotics and 70% (n = 444) do not routinely use pharmacological DVT prophylaxis preoperatively. Open juxta umbilical is the preferred method of pneumoperitoneum for most patients used by 64.6% of surgeons (n = 410) but in patients with advanced obesity (BMI > 35 kg/m2, only 42% (n = 268) would use this technique and only 32% (n = 203) would use this technique if the patient has had a previous laparotomy. Most surgeons (57.7%; n = 369) prefer blunt ports. Liga clips and Hem-o-loks® were used by 66% (n = 419) and 30% (n = 186) surgeons respectively for controlling cystic duct and (n = 477) 75% and (n = 125) 20% respectively for controlling cystic artery. Almost all (97.4%) surgeons felt it was important or very important to remove stones from Hartmann's pouch if the surgeon is unable to perform a total cholecystectomy. CONCLUSIONS This study highlights significant variations in practices concerning various aspects of laparoscopic cholecystectomy.
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Affiliation(s)
- Matta Kuzman
- Health Education England North East, Newcastle upon Tyne, UK
| | | | - Islam Omar
- Wirral Hospital NHS Trust: Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, UK
| | - Hany Khalil
- Oxford University Hospitals NHS Trust: Oxford University Hospitals NHS Foundation Trust, London, UK
| | - Wah Yang
- Department of Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Prem Thambi
- Health Education England North East, Newcastle upon Tyne, UK
| | | | | | - Thomas Kidd
- Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - Altaf Awan
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Mark Taylor
- Belfast Health and Social Care Trust, Belfast, UK
| | - Kamal Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
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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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