A study of preoperative factors associated with a poor outcome following laparoscopic bile duct exploration

Noble, Hamish; Whitley, Elise; Norton, Sally A.; Thompson, Mark J.

doi:10.1007/s00464-010-1146-3

“…For example, Tinoco and colleagues 7 recently reported 481 laparoscopic CBD explorations, of which 69 were formal choledochotomy, and Riciardi and colleagues 12 reported 76 transductal procedures out of 346 explorations. 5,7,8,12 In the present study, postoperative adverse outcomes occurred in 23.9% of patients. In this group, Clavien grade II-V complications occurred in 21.4% of patients, retained CBD stones were observed in 4%, and conversion to laparotomy occurred in 3.5%.…”

Section: Discussionsupporting

confidence: 44%

“…5,7,8 To the best of our knowledge, only 1 published study has specifically evaluated the predictors relating to poor outcomes after laparoscopic bile duct exploration. 8 However, in that report, they also pool the results of laparoscopic transductal, transcystic and radiological ex ploration. In Asian reports, the success rates of transcystic exploration are much lower than those in Western reports.…”

mentioning

confidence: 99%

Celebrity traumatic deaths: Are gangster rappers really “gangsta”?

Ball

¹

,

Dixon

²

,

Parry

³

et al. 2013

cjs

View full text Add to dashboard Cite

Background: Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. Methods:We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evalu ate diagnostic accuracy. Results:We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula:According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. Conclusion:High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.Contexte : La chirurgie laparoscopique pour extraction de calculs biliaires logés dans le cholédoque diffère sur le plan technique de la cholédochotomie laparoscopique (CL) par approche transcystique avec ou sans drain biliaire. Toutefois, la CL est une intervention délicate, qui s'accompagne d'un taux de morbidité documenté plus élevé comparativement à l'extraction transcystique. Nous avons analysé rétrospectivement les facteurs de risque à l'égard d'une issue négative de la CL.Méthodes : Nous avons utilisé des modèles de régression logistique pour évaluer 4 catégories d'issue négative : issue négative globale, complications, conversion vers une chirurgie ouverte et échec de l'extraction chirurgicale. Nous avons calculé l'aire sous la courbe de la fonction d'efficacité du récepteur pour évaluer la précision diagnostique.Résultats : Nous avons inclus dans notre analyse 201 patients soumis à une CL. Une issue négative est survenue chez 48 patients (23,9 %), des complications chez 43 (21,4 %), la persistance des calculs chez 8 (4 %) et la conversion vers la laparotomie chez 7 (3,5 %). L'analyse multivariée a montré que la bilirubine totale ( Conclusion : Un taux de BIL élevé et la présence de FRM pourraient prédire l'issue négative chez des patients soumis à une CL.

show abstract

“…These outcomes are relatively similar to those observed in other studies. 5,6,8,10,13 According to the data from multivariate analysis, the serum BIL and the presence of MRFs were significantly associated with adverse outcomes. The presence of toxic substances, such as BIL and bile salts, impaired liver function, and altered nutritional status due to obstructive jaundice have been characterized as factors for the development of complications, including acute renal failure, cardiovascular depression, hemorrhage from vitamin K deficiency and septicaemia.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 An obstructed biliary tree is likely to be infected and, as a consequence, there will be a higher incidence of severe chronic cholecystitis found at operation, necessitating conversion. 8 In addition, patients with higher BIL were more likely to undergo an emergency operation, and an emergency operation was a risk factor for poor outcomes. 16 As a result, BIL was one of the risk factors for adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study

Ye

¹

,

Hong²,

Ni³

et al. 2013

cjs

View full text Add to dashboard Cite

Background: Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. Methods:We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evalu ate diagnostic accuracy. Results:We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula:According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. Conclusion:High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.Contexte : La chirurgie laparoscopique pour extraction de calculs biliaires logés dans le cholédoque diffère sur le plan technique de la cholédochotomie laparoscopique (CL) par approche transcystique avec ou sans drain biliaire. Toutefois, la CL est une intervention délicate, qui s'accompagne d'un taux de morbidité documenté plus élevé comparativement à l'extraction transcystique. Nous avons analysé rétrospectivement les facteurs de risque à l'égard d'une issue négative de la CL.Méthodes : Nous avons utilisé des modèles de régression logistique pour évaluer 4 catégories d'issue négative : issue négative globale, complications, conversion vers une chirurgie ouverte et échec de l'extraction chirurgicale. Nous avons calculé l'aire sous la courbe de la fonction d'efficacité du récepteur pour évaluer la précision diagnostique.Résultats : Nous avons inclus dans notre analyse 201 patients soumis à une CL. Une issue négative est survenue chez 48 patients (23,9 %), des complications chez 43 (21,4 %), la persistance des calculs chez 8 (4 %) et la conversion vers la laparotomie chez 7 (3,5 %). L'analyse multivariée a montré que la bilirubine totale ( Conclusion : Un taux de BIL élevé et la présence de FRM pourraient prédire l'issue négative chez des patients soumis à une CL.

show abstract

“…The authors' study on the preoperative factors associated with a poor outcome after laparoscopic bile duct exploration made an interesting read [1]. It seems to have been proven beyond doubt that laparoscopic bile duct exploration is more efficient and as safe as endoscopic sphincterotomy in young patients fit for GA.…”

mentioning

confidence: 99%