Protocol driven management of suspected common duct stones: A Southwestern Surgical Congress multi-centered trial.

Autor: Hall C; Baylor Scott & White Health, Department of Surgery, Temple, TX, USA., Regner JL; Baylor Scott & White Health, Department of Surgery, Temple, TX, USA., Schroeppel T; UCHealth, Department of Surgery, Colorado Springs, CO, USA., Rodriguez J; UCHealth, Department of Surgery, Colorado Springs, CO, USA., McIntyre R Jr; University of Colorado, Department of Surgery, Denver, CO, USA., Wright F; University of Colorado, Department of Surgery, Denver, CO, USA., Dissanaike S; Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA., Richmond R; Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA., Santos A; Texas Tech University Health Science Center, Department of Surgery, Lubbock, TX, USA., Frazee RC; Baylor Scott & White Health, Department of Surgery, Temple, TX, USA. Electronic address: Richard.frazee@bswhealth.org.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2019 Dec; Vol. 218 (6), pp. 1152-1155. Date of Electronic Publication: 2019 Sep 14.
DOI: 10.1016/j.amjsurg.2019.09.009
Abstrakt: Background: Several options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population.
Methods: Patients from four participating institutions with a peak bilirubin <4 mg/dL underwent surgery as the initial procedure, whereas patients with a bilirubin ≥4 mg/dL underwent endoscopy. The primary endpoint was length of stay. Analysis involved chi square and Wilcoxon-Mann-Whitney test with significance at p < 0.05.
Results: 214 patients were managed under the protocol during six-month study period. 111 patients (52%) required endoscopy and surgery. Length of stay and the number of MRCPs performed pre-operatively significantly decreased following protocol implementation (p < 0.05).
Conclusions: "Surgery first" approach in patients with bilirubin <4 ml/dL resulted in low morbidity and mortality, reduced MRCP, and length of stay.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: