Antegrade balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration for the acute care surgeon

Bosley, Maggie E.; Nunn, Andrew M.; Westcott, Carl; Neff, Lucas P.

doi:10.1097/ta.0000000000003478

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…While some surgeons are still uncomfortable with the routine use of LCBDE, 18 19 performing bile duct exploration at the time of LC has been shown to be safe with reduced costs and hospital LOS. 11 14 15 20–22 Our data confirm previous studies showing a significantly shorter LOS for those who underwent LC+LCBDE versus ERCP followed by LC.…”

Section: Discussionmentioning

confidence: 99%

“…The technique for common bile duct exploration is standardized within our ACS model. A transcystic catheter-based approach, as has previously been described by this group, was employed 17 18. In brief, after confirmation of common bile duct stone via intraoperative cholangiography (IOC), a cystic duct ductotomy is made and a 0.035″ floppy guidewire is inserted into the cystic duct, traversing the common bile duct, and ending in the duodenum.…”

Section: Methodsmentioning

confidence: 99%

“…In brief, after confirmation of common bile duct stone via intraoperative cholangiography (IOC), a cystic duct ductotomy is made and a 0.035″ floppy guidewire is inserted into the cystic duct, traversing the common bile duct, and ending in the duodenum. Antegrade balloon sphincteroplasty is then performed at the ampulla of Vater to facilitate common bile duct clearance 17 18. Clearance was confirmed with use of IOC.…”

Section: Methodsmentioning

confidence: 99%

“…The overall lack of data on LCBDE irrespective of the time of day is likely due to the declining utilization of LCBDE given the additional time and perceived complexity that LCBDE adds to the operation 16. Despite this, there is a renewed interest among ACS surgeons in treating these additional dimensions of benign biliary disease 15 17 18. To make LCBDE relevant to an ACS practice, we must understand whether nighttime LC+LCBDE can be effectively integrated into a service that operates around the clock.…”

Section: Introductionmentioning

confidence: 99%

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Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

Stettler

Ganapathy

Bosley

et al. 2023

Trauma Surg Acute Care Open

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ObjectivesAlthough controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with LC with endoscopic retrograde cholangiopancreatography (ERCP) but increases case complexity/time. The influence of time of day on LCBDE outcomes has not been evaluated. Our aim was to examine outcomes and LOS for nighttime (PM) compared with daytime LC+LCBDE (DAY).MethodsConsecutive patients who underwent LCBDE were reviewed. Demographics, operative duration, success of LCBDE, time to postoperative ERCP (if required), LOS, and complications were compared. PM procedures were defined as beginning 19:00–07:00 hours.ResultsBetween 2018 and 2022, sixty patients underwent LCBDE (PM 42%). Groups had equivalent age/sex and preoperative liver function tests (LFTs). LCBDE success was 69% PM versus 71% DAY (p=0.78). Operative duration did not differ (2.8 IQR: 2.2–3.3 hours vs. 2.8 IQR: 2.3–3.2 hours, p=0.9). LOS was compared, and PM LOS was shorter (p=0.03). Time to ERCP after a failed LCBDE at night was compared with daytime (13.8 IQR: 10.6–29.5 hours vs. 19.9 IQR: 18.7–54.4 hours, p=0.07). LOS forfailedPM LCBDE requiring ERCP was similar tosuccessfulDAY LCBDE (p=0.29). One complication (transient hyperbilirubinemia) was reported in the DAY group, none in PM.ConclusionPM LCBDE cases are equivalent in safety and success rate to DAY cases but have reduced LOS. Widespread adoption of acute care surgery-driven management of choledocholithiasis via LCBDE during cholecystectomy may decrease LOS, especially in PM cases.Level of evidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

Stettler

Ganapathy

Bosley

et al. 2023

Trauma Surg Acute Care Open

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“…After successful placement of the guidewire into the duodenum, the ureteral stent was removed and the balloon catheter was advanced over the wire into the duodenum. 15 Balloon catheter size was chosen based on the size of the common bile duct, ensuring never to dilate the sphincter larger than the size of the common duct. Common balloon specifications were 6 mm or 8 mm (balloon diameter) Â 40 mm (balloon length) and 75 cm (entire catheter length).…”

Section: Surgical Techniquementioning

confidence: 99%

Reclaiming the management of common duct stones in acute care surgery

Bosley

Ganapathy²,

Sanin³

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Acute care surgery (ACS) is well positioned to manage choledocholithiasis at the time of laparoscopic cholecystectomy, but barriers to laparoscopic common bile duct exploration (LCBDE) include experience and the perceived need for specialized equipment. The technical complexity of this pathway is generally seen as challenging. As such, LCBDE is historically relegated to the “enthusiast.” However, a simplified, effective LCBDE technique as part of a “surgery first” strategy could drive wider adoption in the specialty most often managing these patients. To determine efficacy and safety, we sought to compare our initial ACS-driven experience with a simple, fluoroscopy-guided, catheter-based LCBDE approach during laparoscopic cholecystectomy (LC) to LC with endoscopic retrograde cholangiopancreatography (ERCP). METHODS We reviewed ACS patients who underwent LCBDE or LC + ERCP (pre−/postoperative) at a tertiary care center in the 4 years since starting this surgery first approach. Demographics, outcomes, and length of stay (LOS) were compared on an intention to treat basis. Laparoscopic common bile duct exploration was performed via using wire/catheter Seldinger techniques under fluoroscopic guidance with flushing or balloon dilation of the sphincter as needed. Our primary outcomes were LOS and successful duct clearance. RESULTS One hundred eighty patients were treated for choledocholithiasis with 71 undergoing LCBDE. The success rate of catheter-based LCBDE was 70.4%. Length of stay was significantly reduced for the LCBDE group compared with the LC + ERCP group (48.8 vs. 84.3 hours, p < 0.01). Of note, there were no intraoperative or postoperative complications in the LCBDE group. CONCLUSION A simplified catheter-based approach to LCBDE is safe and associated with decreased LOS when compared with LC + ERCP. This simplified step-up approach may help facilitate wider LCBDE utilization by ACS providers who are well positioned for a timely surgery first approach in the management of uncomplicated choledocholithiasis. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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Outcomes following balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration

et al. 2022

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Antegrade balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration for the acute care surgeon

Cited by 16 publications

References 20 publications

Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

Reclaiming the management of common duct stones in acute care surgery

Outcomes following balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration

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