Management of Choledocholithiasis in a Community Hospital: Laparoscopic Common Bile Duct Exploration Versus Endoscopic Retrograde Cholangiopancreatography.

Autor:	McNamee MM; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Stolz MP; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Harvell RT; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Staley CA; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Green EE; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Othman HD; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA., Gibson BH; Department of Trauma and Acute Care Surgery, Northeast Georgia Health System, Gainesville, GA, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2024 Aug; Vol. 90 (8), pp. 2011-2013. Date of Electronic Publication: 2024 Apr 01.
DOI:	10.1177/00031348241241626
Abstrakt:	Background: Approximately 10% of intraoperative cholangiograms identify choledocholithiasis (CDL), stones in the common bile duct. Choledocholithiasis management options include endoscopic retrograde cholangiopancreatography (ERCP) followed by cholecystectomy, laparoscopic cholecystectomy (LC) followed by ERCP (LC + ERCP), cholecystectomy with open common bile duct exploration, or laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LC + LCBDE). The goal of these interventions is to clear the obstruction from CDL. Methods: Patients from a single-center community hospital undergoing LC with intraoperative cholangiogram (LC + IOC) progressing to LC + LCBDE from July 2020 to August 2022 were evaluated for hospital length of stay (LOS), operative times, and complications. These were compared to the prior standard practice of pre/post-operative ERCP. Results: The results were evaluated using ANOVA, Student-Newman-Keuls, and chi square analysis. In comparison of LC + CBDE to ERCP + cholecystectomy, LOS was reduced (1.8 vs 4.6 days P < .0001). No difference in LOS between LC + IOC and LC + CBDE (1.4 vs 1.8 days, P > .05) was found. No difference in complication rates was found. Mean operative time differed between LC + IOC and LC + CBDE (63 vs 113 minutes, P < .0001). Fifty-five attempts of LC + CBDE were performed with only 10 requiring post-operative ERCP. Discussion: Since implementation of LC + CBDE, there has been reduced LOS without increasing complication rates. Operative times are increased with LC + CBDE but offset by reduced LOS, additional anesthesia events, and procedures. Our institution will continue to pursue LC + CBDE when indicated with efforts to improve resource allocation. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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