Laparo-endoscopic rendez-vous versus sequential 'delayed' approach in patients with choledocholithiasis
| Autor: | Antonio Pesce, Saverio Latteri, Domenico Russello, Federica Di Marco, Michele Di Blasi, Stefano Puleo, Gaetano La Greca, Vincenzo Guardabasso |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Biliary stones medicine.medical_specialty Time Factors medicine.medical_treatment Operative Time cholangiography 03 medical and health sciences Postoperative Complications 0302 clinical medicine Patient age rendezvous medicine Humans In patient Laparoscopic cholecystectomy Aged Cholangiopancreatography Endoscopic Retrograde Biliary stones cholangiography rendezvous business.industry Open surgery Gallstones Length of Stay Middle Aged medicine.disease Conversion to Open Surgery Sequential treatment Surgery Clinical trial Choledocholithiasis Cholecystectomy Laparoscopic 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology Cholecystectomy business |
| Popis: | Background The aim of this study was to compare the efficacy and safety of synchronous laparoscopic cholecystectomy with laparo-endoscopic rendez-vous (LRV) technique vs. sequential "delayed" approach with the main goal to compare the conversion rate and postoperative complications. Methods Patients diagnosed as having gallstones and CBD stones or sludge were enrolled in this study. From January 2013 to June 2015, 43 consecutive patients were submitted to the sequential treatment (ERCP prior to laparoscopic cholecystectomy) and the next consecutive 46 patients were submitted to undergo the rendez-vous technique. All endoscopic procedures in both groups were performed by the same endoscopist with the same technique. Data were collected on patient age, gender, latency operation time, duration of surgery, bilio-pancreatic events, hospital stay, mortality, conversion rate and postoperative complications. Results The overall mean age was 58 years-old (25-84 years) with 43 males (48.3%) and 46 females (51.7%). The conversion rate to open surgery was 11.6% in the "sequential group" vs. 2.2% in the LRV group with a P value 0.10. The reasons for conversion included in the first group unclear anatomy (in 2 patients) and severe adhesions (in the remnant 3 patient), and in the second group unclear anatomy (in one patient). No bilio-pancreatic events occurred in the waiting period for LC in the first group. No mortality was recorded in either group. Postoperative complications were seen in 7% of patients in the "sequential group" vs. 2.2% in the rendez-vous group (P value 0.35). Conclusions LRV does not present real advantages in comparison to delayed sequential approach in terms of conversion rate and postoperative complications. However, these results require further elaboration in studies on large numbers of patients undergoing LRV approach. |
| Databáze: | OpenAIRE |
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