Single-incision laparoscopic common bile duct exploration in 101 consecutive patients: choledochotomy, transcystic, and transfistulous approaches
| Autor: | Hurng-Sheng Wu, Min-Chang Hung, Dev-Aur Chou, Shu-Hung Chuang, Shih-Wei Huang |
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| Rok vydání: | 2017 |
| Předmět: |
Laparoscopic surgery
Adult Male medicine.medical_specialty medicine.medical_treatment Cholecystitis Acute Operative Time law.invention 03 medical and health sciences Leukocyte Count Young Adult 0302 clinical medicine Postoperative Complications Randomized controlled trial law Risk Factors Internal medicine medicine Humans Prospective Studies APACHE Aged Aged 80 and over Common Bile Duct APACHE II Bile duct business.industry General surgery Age Factors Hepatology Middle Aged medicine.disease Conversion to Open Surgery Surgery Biliary Tract Surgical Procedures medicine.anatomical_structure Choledocholithiasis 030220 oncology & carcinogenesis Concomitant Cholecystitis 030211 gastroenterology & hepatology Female Laparoscopy business Learning Curve Abdominal surgery |
| Zdroj: | Surgical endoscopy. 32(1) |
| ISSN: | 1432-2218 |
| Popis: | Laparoscopic surgery for choledocholithiasis is still evolving. Only a few reports of single-incision laparoscopic common bile duct exploration (LCBDE) have been published. One hundred and one consecutive patients underwent single-incision LCBDE (SILCBDE) by one surgeon with straight instruments during a 42-month period. Choledochotomies were performed on 61 patients (60.4%). The success rate of intrahepatic duct exploration was 68.0% (17/25) for patients undergoing transcystic choledochoscopic bile duct explorations following longitudinal cystic ductotomies. The ductal clearance rate was 100%. Eighteen procedures (17.8%) were converted, including one open surgery. Nineteen patients (18.8%) experienced 26 episodes of complications; the majority (19 episodes) were classified as Clavien–Dindo grade I. Excluding those patients with Mirizzi syndrome (McSherry type II), multivariate logistic regressions showed that patients who were older or had complicated cholecystitis had higher procedure conversion rates and that higher modified APACHE II scores, higher white blood cell counts, and longer operative times were independent risk factors for complications. Based on operative times, 20 successful SILCBDEs were needed to get through the learning phase. A higher transcystic approach rate (46.5 vs. 8.3%; P |
| Databáze: | OpenAIRE |
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