Safe laparoscopic clearance of the common bile duct in emergently admitted patients with choledocholithiasis and cholangitis

Kristaps Atstupens; Haralds Plaudis; Vladimirs Fokins; Maksims Mukans; Guntars Pupelis

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저자정보: Kristaps Atstupens (Riga East University Hospital) Haralds Plaudis (Riga East University Hospital) Vladimirs Fokins (Riga East University Hospital) Maksims Mukans (Riga East University Hospital) Guntars Pupelis (Riga East University Hospital)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제20권 제2호

발행연도: 2016.5

수록면: 53 - 60 (8page)

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Backgrounds/Aims: Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis. Methods: Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups. Results: Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate. Conclusions: Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis.

#Choledocholithiasis #Laparoscopic surgery #Cholangitis #Ultrasound #Intraoperative #Choledochoscopy

참고문헌 (34)

참고문헌 신청

Freitas ML, Bell RL, Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol 2006;12:3162-3167.

Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-918.

Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, et al; Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc 2005;62:1-8.

Hublet A, Dili A, Lemaire J, Mansvelt B, Molle G, Bertrand C. Laparoscopic ultrasonography as a good alternative to intraoperative cholangiography (IOC) during laparoscopic cholecystectomy: results of prospective study. Acta Chir Belg 2009; 109:312-316.

Aziz O, Ashrafian H, Jones C, Harling L, Kumar S, Garas G, et al. Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: a meta-analysis of diagnostic accuracy. Int J Surg 2014;12:712-719.

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