Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines

Dijk, Aafke H. van; Reuver, Philip R. de; Besselink, Marc G.; Laarhoven, K.J. van; Harrison, Ewen M; Wigmore, Stephen J.; Hugh, Tom; Boermeester, Marja A.

doi:10.1016/j.hpb.2016.12.011

Cited by 66 publications

(33 citation statements)

References 40 publications

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“…The presence of gallbladder polyps causes a clinical problem, since surgery is only absolutely indicated for neoplastic polyps, including adenomas in view of their assumed malignant potential [ 10 – 13 ]. While international guidelines have various recommendations for the indication of cholecystectomy in general [ 14 ], it is of interest that American [ 15 ] and other western countries [ 16 – 18 ] advocate cholecystectomy for polyps ≥ 1 cm. For polyps < 1 cm, cholecystectomy is only suggested in patients with additional risk factors for malignancy (e.g., older age or primary sclerosing cholangitis (PSC)) or in case of biliary symptoms without alternative causes [ 16 , 17 ].…”

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confidence: 99%

Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps

et al. 2018

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Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps

et al. 2018

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“…There are many and different possible treatments that require several skills and specific indication according to the clinical history. Lack of a worldwide consensus on this clinical scenario may be the biggest impediment to establishing guidelines for managing this condition but, when it is possible, the one-stage approach is preferable [21, 22]. We have demonstrated that it is possible to address patients pre-operatively to direct them towards a specific treatment in order to obtain better technical and organizational management of the surgery and a more personalized approach to the patient’s disease.…”

Section: Discussionmentioning

confidence: 99%

How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Bove

Panaccio

Renzo

et al. 2019

Gastroenterology Report

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Background We utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure. Methods A total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment. According to several pre-operative parameters, 141 patients had to supposedly undergo transcystic clearance of the bile duct, while 39 patients had to be treated with the rendezvous technique. All patients were treated with the sequential procedure: first, we tried the transcystic procedure and, if there was a failure, we used a rendezvous technique. We prospectively analysed each group based on a series of variables such as sex, age, operative time, success rate of proposed treatment, conversion rate, post-operative complications and hospital stay. Results Transcystic clearance was successful in 134 out of 141 patients (95.0%), while 2 patients needed to undergo a laparo-endoscopy procedure (failure). Thirty-five out of 39 patients (89.7%) obtained common bile-duct (CBD) clearance through the rendezvous technique, while 1 patient obtained clean-up through the simple transcystic procedure (failure). Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5% and 7.7%, respectively. Post-operative complications showed similar percentages for both procedures. However, the surgical time turned out to be longer for the rendezvous technique. Conclusions The one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94% of the cases utilizing a surgical technique selected according to the patient’s case history. The pre-operative parameters, such as jaundice, CBD diameters and stone diameters, have certified their reliability as good predictors of the most suitable procedure to follow.

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“…1 , 2 Since its introduction, the length of stay (LOS) associated with LC has steadily reduced and it is now widely accepted as an appropriate and safe ambulatory procedure in carefully selected patients. 2 , 3 , 4 , 5 Implementation of standard clinical pathways for LC have been reported to successfully reduce LOS and increase day case success. 6 , 7 , 8 , 9 , 10 , 11 , 12 Day case laparoscopic cholecystectomy (DCLC) is associated with cost-savings 3 , 13 , 14 without increasing the risk of adverse events or readmissions.…”

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Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

Ryan

OʼConnell

Rogers

et al. 2021

HPB

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Background Laparoscopic cholecystectomy is a safe ambulatory procedure in appropriately selected patients; however, day case rates remain low. The objective of this systematic review and meta-analysis was to identify interventions which are effective in reducing the length of stay (LOS) or improving the day case rate for elective laparoscopic cholecystectomy. Methods Comparative English-language studies describing perioperative interventions applicable to elective laparoscopic cholecystectomy in adult patients and their impact on LOS or day case rate were included. Results Quantitative data were available for meta-analysis from 80 studies of 10,615 patients. There were an additional 17 studies included for systematic review. The included studies evaluated 14 peri-operative interventions. Implementation of a formal day case care pathway was associated with a significantly shorter LOS (MD = 24.9 h, 95% CI, 18.7–31.2, p < 0.001) and an improved day case rate (OR = 3.5; 95% CI, 1.5–8.1, p = 0.005). Use of non-steroidal anti-inflammatories, dexamethasone and prophylactic antibiotics were associated with smaller reductions in LOS. Conclusion Care pathway implementation demonstrated a significant impact on LOS and day case rates. A limited effect was noted for smaller independent interventions. In order to achieve optimal day case targets, a greater understanding of the effective elements of a care pathway and local barriers to implementation is required.

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Assessment of available evidence in the management of gallbladder and bile duct stones: a systematic review of international guidelines

Abstract: Only five guidelines on gallstones are evidence-based and of a high quality, but even in these controversy exists on important topics. High quality evidence is needed in specific areas before an international guideline can be developed and endorsed worldwide.

Cited by 66 publications

References 40 publications

Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps

Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps

How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

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