Laparoscopic Transcystic Common Bile Duct Exploration in the Emergency Is as Effective and Safe as in Elective Setting

Czerwonko, Matías E.; Pekolj, Juan; Uad, Pedro; Mazza, Oscar; Sanchez-Clariá, Rodrigo; Arbúes, Guillermo; Santibañés, Eduardo de; Santibañes, Martín de; Palavecino, Martín

doi:10.1007/s11605-018-4029-x

Cited by 17 publications

(7 citation statements)

References 36 publications

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“…This is because additional anesthesia is not required and complications such as pancreatitis, cholangitis, and duodenal perforation are avoided. 33 This is relevant because the skills associated with IOC provide an excellent foundation for LCBDE and therefore with routine application of IOC one may develop confidence in performing LCBDE. 33 The arguments regarding increased operative time may be mitigated with the fact with routine performance of IOC the staff may be more adept with the set-up of the IOC equipment and shorter IOC procedure length compared to those who perform IOC occasionally.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Hall

Amatya

Shanmugasundaram

et al. 2023

JSLS

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Background/Objectives: Routine intraoperative cholangiography (IOC) for laparoscopic cholecystectomy (LC) remains controversial. The primary outcomes of this meta-analysis were detection rates of choledocholithiasis, bile duct injuries (BDI), and missed stones in LCs.Methods: A systematic literature search was conducted for the time period January 1, 1990 to July 31, 2022. Some studies reported LCs with conversion to open therefore subgroup analysis in BDI rates was performed for studies which included LCs with and without conversion to open. Studies including primary open cholecystectomies were excluded. I 2 statistics were used for heterogeneity analysis.Results: Fourteen studies involving 440659 patients were included. In studies comparing routine and selective IOC policies in LC, 61.1% of patients underwent routine IOC; 38.9% underwent selective IOC. In studies comparing IOC to no IOC in LC, 17.3% of patients had IOC; 82.7% did not. Between the selective and routine IOC groups there was no difference in choledocholithiasis detection rate (odds ratio [OR] = 1.33, p = 0.20, 95% confidence interval [CI] = 0.86 -2.04), no difference in the rate of missed stones (OR = 1.59, p = 0.58; 95% CI = 0.31 -8.29), and no difference in BDI rates in selective compared to routine IOC (OR = 0.92, p = 0.92; 95% CI = 0.20 -4.22). There was no difference in the BDI detection rates in LC with and without IOC (OR = 1.12, p = 0.77; 95% CI = 0.52 -2.38).Conclusion: This is the largest meta-analysis on this topic to date. There was no statistically significant difference in choledocholithiasis detection, missed stones, or BDI rates in the analyzed groups.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Hall

Amatya

Shanmugasundaram

et al. 2023

JSLS

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“…LC + LCBDE + intraoperative ENBD has shorter hospital stays, lower surgery expenditures, postoperative complications and higher success rate than ERCP + subsequent LC. LTCBDE has gained wide applicability with the priority of shorter hospital stays, lower hospital costs and fewer postoperative complications over two aforementioned methods [26,27]. However, the surgical success rate of LC + laparoscopic transcystic CBD exploration varies between 55 and 85% due to cystic duct anatomical features and stone characteristics [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

“…LTCBDE has gained wide applicability with the priority of shorter hospital stays, lower hospital costs and fewer postoperative complications over two aforementioned methods [ 26 , 27 ]. However, the surgical success rate of LC + laparoscopic transcystic CBD exploration varies between 55 and 85% due to cystic duct anatomical features and stone characteristics [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis: six years’ experience of a single institution

et al. 2021

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Introduction The optimal treatment of choledocholithiasis combined with cholecystolithiasis remains controversial. Common surgical methods vary among endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC), laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic transductal common bile duct exploration (LCBDE) with or without T-tube drainage. The purpose of this study is to evaluate the safety and effectiveness of surgical methods and to determine the appropriate procedure for patients with cholecystolithiasis combined with choledocholithiasis. Methods From January 2013 to January 2019, a total of 1555 consecutive patients diagnosed with cholecystolithiasis combined with choledocholithiasis who underwent surgical treatment in Tongji Hospital were retrospectively analyzed. Total 521 patients with intrahepatic bile duct stones underwent LC + LCBDE + T-Tube were excluded from the analysis. At last, 1034 patients who met the inclusion criteria were divided into three groups according to their surgical methods: preoperative ERCP + subsequent LC (ERCP + LC group, n = 275), LC + LCBDE + intraoperative endoscopic nasobiliary drainage (ENBD) + primary duct closure (Tri-scope group, n = 479) and LC + laparoscopic transcystic CBD exploration (LTCBDE group, n = 280). Clinical records, operative findings and postoperative follow-up were collected and analyzed. Results There was no mortality in three groups. Common bile duct (CBD) stone clearance rate was 97.5% in ERCP + LC group, 98.7% in Tri-scope group, and 99.3% in LTCBDE group. There were no difference in terms of demographic characteristics, biochemistry findings and presentations, but the Tri-scope group had the biggest diameter and amount of stones and diameter of CBD, the LTCBDE group had the least CBD stones and the biggest diameter of cystic gall duct (CGD). ERCP + LC group have the longest hospital stay (14.16 ± 3.88 days vs 6.92 ± 1.71 days vs 10.74 ± 5.30 days, P < 0.05), also has the longest operative time than others (126.08 ± 42.79 min vs 92.31 ± 10.26 min, 99.09 ± 8.46 min, P < 0.05). Compared to ERCP + LC group, LTCBDE group and Tri-scope group had lower postoperation-leukocyte, shorter surgery duration and hospital stay (P < 0.05). Compared to the Tri-scope group, the LTCBDE group had the shorter hospital stay, extubation time and operation time and less intraoperative bleeding. There were less postoperative complications in LTCBDE group (1.1%) compared to the ERCP + LC group (3.6%) and Tri-scope group (2.2%). Follow-up time was 6 to 72 months. Four patients in ERCP + LC group and 5 in Tri-scope group reported recurrent stones. Conclusion All the three surgical methods are safe and effective. Tri-scope approach and LTCBDE approach have superiority to preoperative ERCP + LC. LC + LTCBDE shows priority over Tri-scope approach, but should be performed in selected patients. LC + LCBDE + T-Tube can be an alternative management if the other three procedures were failed. The surgeons should choose the most appropriate surgical procedure according to the preoperative examination results and intraoperative situation.

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“…We read an article written by Czerwonko ME et al entitled BLaparoscopic Transcystic Common Bile Duct Exploration in the Emergency Is as Effective and Safe as in Elective Setting^with interest. 1 We congratulate the authors as they have extended the indications for emergency surgery.…”

Section: Dear Editormentioning

confidence: 99%

“Early Elective” rather than “Emergency” Laparoscopic Transcystic Exploration can prevent bile duct exploration/ERCP in half of patients

Maitra

Date

2019

Journal of Gastrointestinal Surgery

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Laparoscopic Transcystic Common Bile Duct Exploration in the Emergency Is as Effective and Safe as in Elective Setting

Cited by 17 publications

References 36 publications

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Intraoperative Cholangiography in Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis: six years’ experience of a single institution

“Early Elective” rather than “Emergency” Laparoscopic Transcystic Exploration can prevent bile duct exploration/ERCP in half of patients

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