Dataset Information

Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series.

ABSTRACT:

Background

Laparoscopic common bile duct exploration (LCBDE) is gaining popularity over endoscopic retrograde cholangiopancreatography (ERCP) for the management of common bile duct stones. However, its application has been almost exclusively following preoperative stone confirmation via magnetic retrograde cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) or ERCP. We present our series of LCBDE following detection of common bile duct stones with intraoperative imaging (IOI) alone, in consecutive elective and emergency patients with suspected choledocholithiasis.

Materials and methods

All patients with suspected but unconfirmed choledocholithiasis undergoing LC with intention to proceed to LCBDE between January 2015 and June 2017 were included. LCBDE was performed following the discovery of choledocholithiasis on IOI.

Results

371 patients with suspected choledocholithiasis underwent LC with IOI. CBD stones or obstructing sludge was identified in 107 patients (29%), with sensitivity of 96.2% and specificity of 98.5%. 100 patients, median age 59, went on to have LCBDE as indicated by intraoperative imaging. 76% were performed as emergency cases and conversion to open rate was 2%. There were no mortalities. Bile leak and retained stones occurred in 4% and 3% respectively. 7/100 patients required re-intervention, with re-look laparoscopy (n?=?4) and ERCP (n?=?3). Median length of stay was 1.5 and 3 days for elective and emergency cases respectively, and 30 readmission rate was 8%.

Discussion and conclusion

Traditionally patients presenting with suspicion of choledocholithiasis undergo preoperative MRCP/EUS and/or ERCP prior to eventual LC. We propose an alternative, more streamlined, pathway of treatment without requiring preoperative cholangiography, applicable to both elective and emergency patients.

SUBMITTER: Platt T

PROVIDER: S-EPMC6249395 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series.

Platt Timothy T Smith Kristy K Nixon Martha M Sinha Surajit S Srinivas Gandrapu G Andrews Stuart S

Annals of medicine and surgery (2012) 20181105

<h4>Background</h4>Laparoscopic common bile duct exploration (LCBDE) is gaining popularity over endoscopic retrograde cholangiopancreatography (ERCP) for the management of common bile duct stones. However, its application has been almost exclusively following preoperative stone confirmation via magnetic retrograde cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) or ERCP. We present our series of LCBDE following detection of common bile duct stones with intraoperative imaging (IOI) al ...[more]

PMID: 30505436

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Project description:Abstract Background Laparoscopic common bile duct exploration with primary closure (LCBDE‐PC) exhibits more benefits than other surgeries for patients with choledocholithiasis. It remains unclear whether it is feasible for and beneficial to elderly individuals. This study aimed to clarify and stratify elderly patients who would benefit from LCBDE‐PC. Methods A retrospective study of 1240 patients with choledocholithiasis who underwent laparoscopic procedures between 2011 and 2019 was conducted. Patients were divided into the young group (<65 years old, n = 708) and the elderly group (≥65 years old, n = 532). Perioperative outcomes were compared between the two groups. Results Laparoscopic common bile duct exploration with primary closure was successfully performed in 90.20% of the elderly and 94.20% of the young. No significant differences were observed between the two groups regarding reoperation, postoperative bile leakage, residual stones, drainage removal, and postoperative mortality. Compared with the young, the elderly had longer postoperative hospital stay (p = 0.035) and delayed postoperative eating time (p = 0.036) in the matched cohort. Independent risk factors for failed LCBDE‐PC were preoperative pancreatitis (p = 0.018), year of the surgeon's experience (p = 0.008), preoperative C‐reactive protein level (p = 0.034), preoperative total bilirubin (p = 0.021), impacted common bile duct (CBD) stones (p = 0.006), blood loss (p = 0.001), and edema of the CBD (p = 0.001). A novel nomogram for predicting failed LCBDE‐PC in elderly individuals exhibited a sufficient discriminative ability according to the estimated area under the curve (AUC) of 0.869 (95% CI: 0.817–0.921, p < 0.01). Conclusion Laparoscopic common bile duct exploration with primary closure is safe, feasible, and effective for elderly individuals with choledocholithiasis. Elderly patients with a high risk of failed LCBDE‐PC should be cautious of undergoing LCBDE‐PC. LCBDE‐PC is a safe, effective, and feasible procedure for treating choledocholithiasis in elderly patients. The novel nomogram, based on abdominal pain, year of the surgeon's experience, pancreatitis, preoperative laboratory data, impacted CBD stones, maximal stone diameter, blood loss, stone clearance, and CBD edema, had relatively good accuracy in assessing the failure risk of LCBDE‐PC, which could enable clinicians to perform better risk stratification in elderly patients when starting treatment.

Dataset Information

Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series.

Background

Materials and methods

Results

Discussion and conclusion

Publications

Success of intraoperative imaging and management of suspected choledocholithiasis without pre-operative bile duct imaging - A case series.

Similar Datasets

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