The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy

Wagner, Amy J.; Sobrino, M. A.; Traverso, L. William

doi:10.1007/s00464-004-8101-0

Cited by 8 publications

(13 citation statements)

References 11 publications

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“…Laparoscopic CBD exploration (LCBDE) was advocated by 61% of surgeons, whereas 25% recommended post‐operative ERCP. In the same paper, LCBDE was found to have similar long term outcomes to post‐operative ERCP . The use of a flexible choledochoscope and wire basket for laparoscopic transcystic stone removal has been described .…”

Section: Discussionmentioning

confidence: 84%

“…Achieving the ‘critical view of safety’ via dissection of Calot's triangle and IOC have both been advocated as gold standard for preventing BDI in LC . Routine IOC was found to reduce the incidence of BDI by up to 50–70% . For example, one retrospective audit describes IOC highlighting the misinterpretation of the CBD as the cystic duct.…”

Section: Discussionmentioning

confidence: 99%

“…In IOC cases where a CBD stone was found, it may be possible to explore the CBD laparoscopically, negating the need for follow‐up ERCP . Laparoscopic CBD exploration (LCBDE) was advocated by 61% of surgeons, whereas 25% recommended post‐operative ERCP.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting

Verma

Wichmann

Gunning

et al. 2016

Australian J Rural Health

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The majority of patients treated in our centre were women, middle-aged patients booked for elective laparoscopic cholecystectomy. Although only 6.7% cases were suspicious for CBD stones pre-operatively, a total of 17% of patients with routine IOC suggested CBD stones. IOC was found to be safe, taking only an additional 28 min of total theatre time. Routine rather than selective use of IOC could be considered to improve patient safety and long-term results.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting

Verma

Wichmann

Gunning

et al. 2016

Australian J Rural Health

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“…A recent published series reported a 71% clearance rate with transcystic exploration and without the use of a choledochoscope. The same report also concluded that long-term outcomes after laparoscopic ductal clearance are similar to those for ERCP clearance [25].…”

Section: Discussionmentioning

confidence: 77%

Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery

et al. 2007

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In this series, 10% of the abnormal cholangiograms occurred in patients without preoperative risk factors for bile duct stones. Altogether, 88 IOCs (31%) were cleared after either simple flushing or trawling with a Dormia basket. Formal LBDE was not required for 40% of abnormal cholangiograms. Simple transcystic manipulations to clear the bile ducts justify the use of routine IOC in units without laparoscopic biliary expertise.

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“…

We read with interest the article by Wagner et al [3]. The authors successfully highlighted that simple transcystic maneuvers may clear common bile duct (CBD) stones in 71% of cases with a positive intraoperative cholangiogram that would otherwise have a postoperative endoscopic retrograde cholangiopancreatography (ERCP).

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confidence: 93%

The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy

Hamouda

Nassar

2006

Surg Endosc

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We read with interest the article by Wagner et al. [3]. The authors successfully highlighted that simple transcystic maneuvers may clear common bile duct (CBD) stones in 71% of cases with a positive intraoperative cholangiogram that would otherwise have a postoperative endoscopic retrograde cholangiopancreatography (ERCP). It remained unclear why patients who had open common bile duct exploration (CBDE) were excluded from the group of patients with attempted transcystic clearance and whether a decision to proceed to open CBDE was made on cholangiographic evidence. Simple transcystic manipulation of CBD stones has been shown to be effective, as evidenced by retained stone clearance in an xray department following saline flushing through a T-tube after 1 mg glucagon injection[1]. In our experience, 52 of 279 abnormal cholangiograms were clear after flushing with glucagon injection (18.6%) and a further 37 were clear after dormia basket trawling under fluoroscopy (13.3%) prior to the insertion of a choledochoscope. However, this was achieved in a series of 1,408 all-comers treated by single-session management, 28% of whom were emergent admissions with deranged LFTs and/or jaundice. In units without the equipment and expertise for performing laparoscopic choledochoscopic bile duct exploration, the normal practice would be preoperative magnetic resonance cholangiopancreatography (MRCP) followed by ERCP for patients with suspected CBD stones. The authors have demonstrated that simple transcystic manipulation can clear the ducts to avoid unnecessary cost and prolonged inpatient stay. The simple techniques described should be easily performed by most surgeons practicing laparoscopic cholecystectomy.The article also stressed the importance of intraoperative cholangiogram as a diagnostic modality deemed by many surgeons as inconsequential. Recent reviews have shown unsuspected retained stones to occur in approximately 4% of patients with gallstones and only 15% of those go on to cause clinical problems [2]. In our experience, 59 patients had abnormal cholangiograms out of 589 with no preoperative clinical, biochemical, or radiological risk (10%). Since a MRCP is almost always required to demonstrate the presence of a CBD stone prior to ERCP, an intraoperative cholangiogram could further save costs by detecting clinically silent stones that might become symptomatic following a laparoscopic cholecystectomy. In all cases, the authors have shown laparoscopic transcystic manipulation to be more cost-effective than postoperative ERCP with similar long-term outcomes, which is a welcome conclusion to balance the rising expenditure on MRCP and reliance on duct clearance by ERCP with its high comorbidity. References 1. Mahmud S, McGlinchey I, Kasem H, Nassar AH (2001) Radiological treatment of retained bile duct stones following recent surgery using glucagon. Surg Endosc 15: 1359-1360 2. Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? ...

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The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy

Cited by 8 publications

References 11 publications

Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting

Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting

Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery

The long-term follow-up of patients with positive intraoperative cholangiograms during laparoscopic cholecystectomy

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