Three modalities on management of choledocholithiasis: A prospective cohort study
| Autor: | Yong-Hua Xu, Wen-Zhang Zha, Ren-Gen Fan, Jing Jia, Biao Zhang, Xu-Dong Wu, Yong Zhou, Cheng-Lin Qin |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment digestive system Gastroenterology 03 medical and health sciences Sphincterotomy Endoscopic 0302 clinical medicine Postoperative Complications Internal medicine medicine Cholecystitis Humans Cholecystectomy Prospective Studies Prospective cohort study Duodenal Perforation Cholangiopancreatography Endoscopic Retrograde Common bile duct Bile duct business.industry General Medicine Length of Stay Middle Aged medicine.disease Combined Modality Therapy digestive system diseases surgical procedures operative medicine.anatomical_structure Choledocholithiasis Treatment Outcome 030220 oncology & carcinogenesis Concomitant Drainage 030211 gastroenterology & hepatology Surgery Female Laparoscopy Bile Ducts Complication business |
| Zdroj: | International journal of surgery (London, England). 44 |
| ISSN: | 1743-9159 |
| Popis: | Background Choledocholithiasis can be managed by endoscopic retrograde cholangiopancreaticography/endoscopic sphincterotomy (ERCP/EST) or laparoscopic common bile duct (CBD) exploration by transcystic (TC) or transductal (TD) stone extraction. Objective The aim of this study was to evaluate the safety and effectiveness of common bile duct stones extraction by ERCP/EST, TC approach and TD approach for choledocholithiasis, with specific emphasis on ERCP/EST, TC approach versus TD approach. Methods Between January 2011 and June 2014, a total of 161 patients were scheduled for two-stage (preoperative ERCP/EST followed by cholecystectomy, ERCP group, n = 52)or single-stage (laparoscopic exploration of the CBD combined with cholecystectomy, n = 109) treatment for choledocholithiasis with concomitant cholecystitis. Laparoscopic common bile duct exploration was performed by TC approach (TC group, n = 63)or TD approach (TD group, n = 46). T-tube insertion was performed in selected patients. Patients were regularly followed up at bimonthly intervals or more frequently in presence of any symptom. Primary outcomes measures included length of hospital stay, successful bile duct clearance, postoperative/procedural morbidity and mortality. Results Successful bile duct clearance was 100.0% in TD group, 93.7% in TC group and 92.3% in ERCP group. 4 cases in the TC group and 4 cases in the ERCP group required an extra choledocholithotomy due to impacted stones. 9 patients underwent T-tube drainage in TD group comparing to 1 case in ERCP group and no cases in TC group. Comparing to TC group, there was more postoperative morbidity in TD and ERCP group. Bile leaks were more frequent in TD group (8.7%) than TC (3.2%) and ERCP group (3.8%), which prolonged hospitalization in TD group than TC and ERCP group. 2 patients in ERCP group suffered duodenal perforation and one of them died because of the complication. However, total procedural morbidity was 0% in TC and TD group. Conclusion TD stone extraction has a higher stone clearance but with a higher risk of bile leaks. Procedural morbidity is more often happened in ERCP/EST, which may result in serious consequences. TC stone extraction, which seems an effective approach with lower complication rates, is accessible techniques simplifying the operation procedure by avoiding choledocholithotomy and subsequent T-tube insertion. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect