A predictive nomogram to identify factors influencing the success of a concomitant laparoscopic cholecystectomy with common bile duct exploration for choledocholithiasis

Chue, Koy Min; Aw, Jun Wei Bryan; Chua, Sin Hui Melissa; Iyer, Shridhar Ganpathi; Madhavan, Krishnakumar; Kow, Alfred Wei Chieh

doi:10.1016/j.hpb.2017.09.005

Cited by 10 publications

(16 citation statements)

References 21 publications

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“…Today, although conventional laparoscopic surgery has become the gold standard for straightforward cholecystectomies with reported open conversion rates of <5%,[ 23 24 ] its use for more complicated biliary operations such as bile duct stones, biliary strictures, Mirizzi syndrome, gallbladder malignancy, biliary malignancies and even severe cholecystitis remain more limited and is associated with relatively high open conversion rates of up to 40%. [ 5 25 26 ] Similarly, although MIPS is increasingly adopted worldwide,[ 27 28 ] the most common approach for PS remains the conventional open approach, and many surgeons remain skeptical about MIPS. [ 29 ] The main concerns raised today by opponents of MIPS are its reproducibility and universal applicability due to the long and steep learning curve reportedly required to learn MIPS and to achieve proficiency.…”

Section: Discussionmentioning

confidence: 99%

Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia

et al. 2020

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Background: Minimally-invasive pancreato-biliary surgery (MIPBS) is increasingly reported worldwide. This study examines the changing trends, safety and outcomes associated with the adoption of MIPBS based on a contemporary experience of an early adopter in Southeast Asia. Methods: Retrospective review of 114 consecutive patients who underwent MIPBS by a single surgeon over 86 months from 2011. The study population was stratified into three equal groups of 38 patients. Comparison was also performed between minimally-invasive pancreato surgery (MIPS) and minimally-invasive biliary surgery (MIBS). Results: There were 70 MIPS and 44 MIBS. Sixty-three cases (55.3%) were performed using robotic assistance and fourteen (12.3%) were hybrid procedures with open reconstruction. Forty-four (38.6%) procedures were performed for malignancy. There were 8 (7.0%) open conversions and median operation time was 335 (range, 60–930) min. There were nine extended pancreatectomies including seven involving vascular reconstructions. Major morbidity (>Grade 2) occurred in 20 (17.5%) patients including 6 (5.3%) reoperations and there was no mortality. Comparison across the three groups demonstrated that with increasing experience, there was a significant trend in a higher proportion of higher ASA score patients, increasing frequency of procedures requiring anastomosis and increasing the use of robotic assistance without significant difference in key perioperative outcomes such as open conversion rate, morbidity and hospital stay. Comparison between MIPS and MIBS demonstrated that MIPS was associated with significantly longer operation time, increased blood loss, increased transfusion rate, longer hospital stay, increased readmission rate and increased morbidity. Conclusion: MIPBS can be safely adopted today with a low open conversion rate.

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Section: Discussionmentioning

confidence: 99%

Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia

et al. 2020

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“…rates of less than 5%, 13,14 its use for more complicated biliary surgeries such as bile duct stones, complicated gallstone disease (gangrenous cholecystitis, Mirizzi syndrome), gallbladder cancer and bile duct cancers remain more limited and is still reported to be associated with relatively high open conversion rates of up to 40%. [14][15][16][17]20 Hence, many surgeons still elect to approach these procedures via the traditional open approach. Presently, with advancements in surgical technique and technology, increasing reports of laparoscopic bilio-enteric anastomosis for various indications such as choledochal cysts and bile duct cancers, [10][11][12]22 have been reported in the literature.…”

Section: Resultsmentioning

confidence: 99%

“…[14][15][16][17]20 Hence, many surgeons still elect to approach these procedures via the traditional open approach. [14][15][16][17]20 Hence, many surgeons still elect to approach these procedures via the traditional open approach.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 However, its use is mainly limited to relatively straightforward conditions such as biliary colic, symptomatic gallstones and early acute cholecystitis. 13,14 When applied to more complicated conditions such as perforated/gangrenous cholecystitis, 15 choledocholithiasis 16 and Mirizzi syndrome, 17,18 the laparoscopic approach has been reported to be associated with high open conversion rates of up to 70%. The use of the laparoscopic approach for even more complicated major biliary surgeries such as for gallbladder cancer, [19][20][21] choledochal cysts, 9,10,12 bile duct cancers 22 and bile duct injuries 23 remain highly limited and is largely performed in a selected few high-volume specialized centres.…”

Section: Introductionmentioning

confidence: 99%

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Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

Goh

Low

Teo

et al. 2019

ANZ Journal of Surgery

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Background: Presently, experience with robotic biliary surgery (RBS) is increasing worldwide although widespread adoption remains limited. In this study, we report our initial experience with RBS. Methods: Retrospective review of a single institution prospective database of 95 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2018. Of these, 27 patients who underwent RBS were included in this study. RBS was performed by three principal console surgeons of whom one surgeon performed 23 (85%) and supervised all cases. Additionally, to evaluate our initial outcomes with bilio-enteric anastomoses, eight consecutive pancreatoduodenectomies were included. Results: Of the 27 RBS performed, these included 10 hepaticojejunostomies with bile duct resections (including two concomitant pancreatoduodenectomies and one right hepatectomy) for choledochal cysts, bile duct strictures and biliary malignancies; five liver resections with hilar lymph node clearance for gallbladder cancer; four for Mirizzi syndrome; two cholecystectomies with cholecystoenteric fistula and two bile duct exploration after failed endoscopic treatment of choledocholithiasis. There were no open conversions, no 90-day mortality and four (14.8%) major (>Grade II) morbidities. The median postoperative stay was 6 (range 1-29) days and there was one (3.7%) 30-day readmissions. Of our first 18 robotically constructed bilio-enteric anastomoses, there was only one (5.5%) early anastomotic complication (bile leak requiring reoperation). Conclusion: Our initial experience demonstrated that RBS can be adopted safely with a low open conversion rate. Robotically constructed bilio-enteric anastomosis can be performed safely with a low anastomotic complication rate.

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“…The open conversion rate of LCBDE varies from 4.2 -43.1%. [20][21][22] Multivariable analysis indicated that the conversion to open surgery was associated with the maximal CBDS diameter (odds ratio, [OR] 2.23), edema of CBD (OR 12.5), and the number of stones (OR 3.438). 21 Another report found that prior antibiotic use (OR 2.98), previous ERCP (OR 4.99), and abnormal biliary anatomy (OR 9.37) were predictors of failed LCBDE.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Laparoscopic Common Bile Duct Exploration by Chopstick Technique in Choledocholithiasis

Suwatthanarak

Akaraviputh

Phalanusitthepha

et al. 2021

JSLS

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Background and Objectives: Laparoscopic cholecystectomy with common bile duct exploration (LC with LCBDE) remains the preferred technique for difficult common bile duct stone (CBDS) removal. The chopstick method uses commonly available instruments and may be cost-saving compared to other techniques. We studied the outcome of LCBDE using the chopstick technique to determine if it could be considered a first-choice method.Methods: Data from all patients that underwent LCBDE from January 1, 2012 to April 30, 2019 were retrospectively analyzed. A standard 4-port incision and CBDS permitted extraction with two laparoscopic instruments by chopstick technique via vertical choledochotomy. Demographic data, stone clearance rate, surgical outcomes, complications, and other associated factors were evaluated.Results: Thirty-two patients underwent LCBDE. The mean number of preoperative endoscopic retrograde cholangiopancreatography (ERCP) sessions was 2.4. In 65.5% of cases, the CBDS was completely removed by the chopstick technique, while 96.9% of stones were removed after using additional tools. The need for additional instruments was associated with increased age, increased numbers of stones, longer period from the latest ERCP session, and previous upper abdominal surgery. The conversion rate to open surgery was 28.1% and was significantly associated with a history of upper abdominal surgery. Conclusion:The chopstick technique is a good alternative and could be considered as a first-line technique in LCBDE to remove the CBDS in cases with 1 to 2 large suprapancreatic CBDS due to instrument availability, cost-effectiveness, and comparable surgical outcomes.

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A predictive nomogram to identify factors influencing the success of a concomitant laparoscopic cholecystectomy with common bile duct exploration for choledocholithiasis

Abstract: LCBDE is useful for the treatment of choledocholithiasis. However, patients who were predicted to have an elevated risk for open conversion might not be ideal candidates for the procedure.

Cited by 10 publications

References 21 publications

Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia

Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

Outcomes of Laparoscopic Common Bile Duct Exploration by Chopstick Technique in Choledocholithiasis

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