An analysis of omitting biliary tract imaging in 668 subjects admitted to an acute care surgery service with biochemical evidence of choledocholithiasis.

Autor: Riggle AJ; Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA., Cripps MW; Division of Burn/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Boulevard, E5.508A, Dallas, TX 75390-9158, USA., Liu L; UT Southwestern School of Medicine, Dallas, TX, USA., Subramanian M; Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, TX, USA., Nakonezny PA; Division of Biostatistics, Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA., Wolf SE; Division of Burn/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Boulevard, E5.508A, Dallas, TX 75390-9158, USA., Phelan HA; Division of Burn/Trauma/Critical Care, Department of Surgery, UT Southwestern Medical Center, Parkland Memorial Hospital, 5323 Harry Hines Boulevard, E5.508A, Dallas, TX 75390-9158, USA. Electronic address: herb.phelan@utsouthwestern.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2015 Dec; Vol. 210 (6), pp. 1140-4; discussion 1144-6. Date of Electronic Publication: 2015 Sep 26.
DOI: 10.1016/j.amjsurg.2015.06.031
Abstrakt: Background: No consensus exists for the timing and utility of biliary imaging in patients with preoperative concern for choledocholithiasis.
Methods: Admissions to an acute care surgery service with evidence of choledocholithiasis undergoing same-admission cholecystectomy without preoperative or intraoperative imaging were identified. One-way analysis of variance on the log-transformed outcomes, with the Tukey-Kramer multiple comparison procedure, were used to compare means between groups.
Results: A total of 668 patients with elevated but downtrending liver enzymes underwent cholecystectomy without preoperative or intraoperative imaging. Thirty-eight patients (5.7%) had postoperative biliary imaging, of whom 22 (3.3%) had definite choledocholithiasis. One case of postoperative cholangitis occurred which required readmission and endoscopic retrograde cholangiopancreatography with no long-term morbidity. Presenting liver enzymes were significantly higher in the group found to have retained stones postoperatively than those without retained stones.
Conclusions: Patients presenting with biochemical evidence of choledocholithiasis who downtrend preoperatively can be safely managed by cholecystectomy with omission of biliary tract imaging.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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