Positive intraoperative cholangiography during laparoscopic cholecystectomy: is laparoscopic common bile duct exploration necessary?
| Autor: | James Blitz, Thomas Vander Laan, Gabriel Akopian |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Balloon Intraoperative Period Cholangiography medicine Humans Laparoscopic cholecystectomy Aged Retrospective Studies Common Bile Duct Common bile duct exploration Endoscopic retrograde cholangiopancreatography Common bile duct medicine.diagnostic_test business.industry General surgery Gallbladder General Medicine Middle Aged Surgery medicine.anatomical_structure Choledocholithiasis Treatment Outcome Cholecystectomy Laparoscopic Cholecystectomy Female business |
| Zdroj: | The American surgeon. 71(9) |
| ISSN: | 0003-1348 |
| Popis: | The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques. |
| Databáze: | OpenAIRE |
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