High rate of stone-related complications after stapling the cystic duct during laparoscopic cholecystectomy-an underrecognized risk.

Autor: Thomas AS; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA. at3215@cumc.columbia.edu.; Division of GI and Endocrine Surgery, Surgery Resident and Postdoctoral Research Fellow, New York Presbyterian Hospital, 8th Floor, Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA. at3215@cumc.columbia.edu., Gleit Z; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA., Younan S; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA., Genkinger J; Department of Epidemiology, Herbert Irving Comprehensive Cancer Center, Columbia University Mailman School of Public Health, New York, NY, USA., Kluger MD; Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jun; Vol. 37 (6), pp. 4707-4718. Date of Electronic Publication: 2023 Mar 08.
DOI: 10.1007/s00464-023-09947-2
Abstrakt: Background: Laparoscopic staplers (LS) have been suggested as a safe alternative to metal clips in laparoscopic cholecystectomy when the cystic duct is too inflamed or wide for complete clip occlusion. We aimed to evaluate the perioperative outcomes of patients whose cystic ducts were controlled by LS and evaluate the risk factors for complications.
Methods: Patients who underwent laparoscopic cholecystectomy with LS used to control the cystic duct from 2005 to 2019 were retrospectively identified from an institutional database. Patients were excluded for open cholecystectomy, partial cholecystectomy, or cancer. Potential risk factors for complications were assessed using logistic regression analysis.
Results: Among 262 patients, 191 (72.9%) were stapled for size and 71 (27.1%) for inflammation. In total, 33 (16.3%) patients had Clavien-Dindo grade ≥ 3 complications, with no significant difference when surgeons chose to staple for duct size versus inflammation (p = 0.416). Seven patients had bile duct injury. A large proportion had Clavien-Dindo grade ≥ 3 postoperative complications specifically related to bile duct stones [n = 29 (11.07%)]. Intraoperative cholangiogram was protective against postoperative complications [odds ratio (OR) = 0.18 (p = 0.022)].
Conclusion: Whether these high complication rates reflect a technical issue with stapling, more challenging anatomy, or worse disease, findings question whether the use of LS during laparoscopic cholecystectomy is truly a safe alternative to the already accepted methods of cystic duct ligation and transection. Based on these findings, an intraoperative cholangiogram should be performed when considering a linear stapler during laparoscopic cholecystectomy to: (1) ensure the biliary tree is free of stones; (2) prevent inadvertent transection of the infundibulum rather than the cystic duct; and, (3) allow opportunity for safe alternative strategies when an IOC is not able to confirm anatomy. Otherwise, surgeons employing LS devices should be aware that patients are at higher risk for complications.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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