| Autor: |
Giurgiu, Dan I., Margulies, Daniel R., Carroll, Brendan J., Gabbay, Joubin, Iida, Atsushi, Takagi, Sumito, Fallas, Moses J., Phillips, Edward H. |
| Předmět: |
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| Zdroj: |
Archives of Surgery; Aug99, Vol. 134 Issue 8, p839, 6p |
| Abstrakt: |
Hypothesis: Transcystic laparoscopic common bile duct exploration (LCBDE) with biliary endoscopy results in excellent long-term clinical outcome and patient satisfaction. Design: Prospective cohort study of unselected patients found to have common bile duct stones during laparoscopic cholecystectomy between October 1989 and April 1998. A mailed survey assessed symptoms, outcome, and satisfaction. Setting: A large community teaching hospital. Patients: Two hundred seventeen patients with common bile duct stones. Intervention: Transcystic LCBDE with choledochoscopy. Main Outcome Measures: Success of LCBDE, morbidity, postoperative symptoms, and satisfaction. Results: One hundred sixteen surveys (54%) were returned. Mean follow-up was 60 months. The LCBDE procedure failed in 6 patients and endoscopic retrograde cholangiopancreatography was performed in 4 patients (3%). One patient had unsuspected retained stones. No patient had late recognition of retained stones or a bile duct stricture. Abdominal pain was present in 90 patients (89%) preoperatively and in 29 patients (26%) postoperatively (P=.001). The LCBDE procedure reduced 3 specific pain profiles: epigastric, from 47% (n=54) to 7% (n=8); back, from 31% (n=36) to 6% (n=7); and shoulder, from 18% (n=21) to 2% (n=2). When pain persisted, it was different in character in 15%. All nonpain symptoms (such as nausea, bloating, indigestion, and gas) were reduced from 78% (n=91) to 34% (n=39) (P=.001) except diarrhea. Diarrhea was present in 24 patients (22%) preoperatively and postoperatively, though it was a new postoperative symptom in 11 patients (11%). One hundred two patients (95%) were satisfied or mostly satisfied with LCBDE. Conclusions: Pain and nonpain symptoms, while reduced significantly after LCBDE, may persist. The LCBDE procedure does not result in common bile duct strictures or a significant rate of retained stones. This relatively new treatment for common bile duct stones is safe and effective. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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