To ‘gram or not’? Indications for intraopertive cholangiogram

Tabone, Lawrence E.; Sarker, Sharfi; Fisichella, P. Marco; Conlon, Molly; Fernando, Emil; Yi, Sophia C; Luchette, Fred A.

doi:10.1016/j.surg.2011.07.062

Cited by 35 publications

(27 citation statements)

References 13 publications

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“…Moreover, the widespread adoption of ERCP, even as a diagnostic tool, enormously impacted the development of some excessively invasive algorithms due to success rates of CBD clearance of almost 98% in the hands of experienced endoscopists [19] . Currently, IOC is routinely performed in some centers [20][21][22] and selectively in others [23,24] , while it is easily reproducible by the majority of surgeons. Nevertheless, the definitive acceptance of one policy over another has not been confirmed [25] , with selective IOC having some advantages in terms of a shorter operating time and fewer perioperative complications but at the price ofa higher readmission rate if CBDS are subsequently detected [22] .…”

Section: Stonesmentioning

confidence: 99%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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Section: Stonesmentioning

confidence: 99%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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“…Centres operating on adults that have elected to perform OTC during LC procedures have based their decision on an inclusion criteria which incorporates traditional indicators for choledocholithiasis [3]. The 4 year 1,308 patient retrospective study by Tabone et al stated that indications for performing OTC included preoperative diagnosis of gallstone pancreatitis, increase in serum bilirubin and an elevated CBD of >10mm.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic Cholecystectomy (LC) is the current best practice in the surgical management of gallstone disease in children [1] [2]; however the use of on table cholangiography (OTC) for routine LC has not been adequately investigated despite it being a frequently debated topic within adult surgical literature [3].…”

Section: Introductionmentioning

confidence: 99%

“…On table cholangiography (OTC) during LC has historically been advocated by surgeons to reduce bile duct injury, identify associated choledocholithiasis, and to avoid post-operative imaging such as Endoscopic Retrograde Cholangiopancreatogrophy (ERCP) [3]. Additionally, the ability to reduce iatrogenic morbidity through increasing anatomical definition has also been a compelling reason for adopting routine OTC during LC [4].…”

Section: Introductionmentioning

confidence: 99%

“…In opposition to routine adopters of OTC, arguments against its use include the increase in morbidity associated with additional anaesthetic time, increased procedure time and heightened departmental costs [3] [5]. Recently, two comprehensive systematic reviews have demonstrated that LC without routine requirement for OTC can be performed safely and effectively, whilst reducing total peri-operative complication [6] [7].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Routine on Table Cholangiography in Paediatric Cholecystectomy

Gurprashad¹

2017

AJP

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Abstract:The use of on table cholangiogram (OTC) during laparoscopic cholecystectomy (LC) continues to be a debated topic within surgical practice. Current National Institute for Health and Care Excellence (NICE) guidelines do not advocate its routine use in adult patients, and there is scarce evidence for its use in paediatric cases. We aimed to analyse the outcomes of OTC during laparoscopic cholecystectomy to see if the NICE guidance holds true for children. A retrospective case note review was performed with IRB approval of all children who underwent laparoscopic cholecystectomy between February 2005 and November 2014. A total of 65 patients were identified, 41 female (63%) and 24 male (37%). The median age was 12 years (IQR 6). None of the patients underwent OTC during their LC. Instead, pre-operative ultrasound scan (USS) was performed in all cases. From the cohort, 5 patients (13%) showed abnormalities; 3 of which had a dilated common bile duct, and 2 of which had bile duct stones. All 5 patients went on to receive additional imaging, 2 patients underwent a repeat USS both of which were normal on review; 1 patient had an Endoscopic Retrograde Cholangio-Pancreatectography (ERCP), stent and follow-up Magnetic Resonance Cholangio-Pancreatograthy (MRCP) which was normal; 1 patient had an MRCP, ERCP with sphincterotomy and a follow-up USS which was normal; and 1 patient had an ERCP with follow-up USS which was also normal. In line with current NICE guidance for adults, our study indicates that patients with common bile duct (CBD) stones or a dilated CBD can be identified and managed prior to laparoscopic cholecystectomy. This would suggest that there is no requirement for OTC in children. Similar NICE guidance in Paediatrics may be necessary to avoid unnecessary intervention.

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