Background: Laparoscopic common bile duct exploration (LCBDE) can be performed to treat choledocholithiasis at the time of laparoscopic cholecystectomy. The aim of this study was to identify factors that predict the success of LCBDE. Materials and Methods:A retrospective audit was performed on patients who underwent LCBDE for the management of choledocholithiasis at Northern Health between 2008 and 2018.Results: A total of 513 patients were identified with an overall success rate of 90.8%. Most LCBDE were done through a transcystic approach with the remainder through a choledochotomy. When comparing patients with a successful operation to those that were unsuccessful, univariate analysis demonstrated significant differences in preoperative white cell count and number of duct stones found. Age and elevated nonbilirubin liver function tests were found to be significant factors associated with the failure of LCBDE on multivariate analysis. The likelihood of a failed operation in those with multiple stones was observed to be almost halved compared with patients with single stone although this did not reach significance [odds ratio (OR): 0.53, 95% confidence interval (CI): 0.28-1.01, P = 0.055]. Multivariate analysis indicated that unsuccessful procedures (OR: 10.13, 95% CI: 4.34-23.65, P < 0.001) and multiple duct stones (OR: 3.79, 95% CI: 1.66-8.67, P = 0.002) were associated with an increased risk of severe complications.Conclusions: A single impacted stone may be more difficult to remove, however complications were more likely to be associated with multiple duct stones. With no other clinically relevant predictive factors, and because of the high success of the procedure and the low morbidity, LCBDE remains an option for all patients with choledocholithiasis.
Method: Total of 106 patients undergoing major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for PHC between 1999 and 2017 were identified. HAT was performed in 60 patients (56.6%). Relationship between HAT and postoperative outcomes was retrospectively assessed. Result: Five-year disease-specific survival (DSS) was 34.2% with a median DSS time of 29.8 months. Patients with HAT were younger (P<0.001), had higher preoperative Hb level (P<0.001), and had lower ASA-PS (P=0.023). These patients resulted in significant reduction of intraoperative blood loss (P=0.016), suppressed allogeneic BT (P=0.001), and reduction of postoperative prothrombin time activity (P=0.002). Significant differences were not observed between the patients with and without HAT in postoperative morbidity (P=0.734). In univariate analysis, preoperative CA19-9 >37 U/mL (P=0.007), preoperative portal vein embolization (P=0.014), right side hepatectomy (P=0.014), combined vascular resection (P=0.022), operative time 480 min (P=0.041), patients without HAT (P=0.006), postoperative complications (P=0.024), lymph node involvement (P<0.001), microvascular invasion (P=0.005), and R1 resection (P=0.026) were significant prognostic factors for poor DSS. In multivariate analysis, patients without HAT (hazard ratio (HR)=1.74, P=0.049) and lymph node involvement (HR=2.15, P=0.045) were the only independent factors. Regarding BT, 5-year DSS rates in the patients who received HAT only (N=44), no BT (N=19), and allogeneic BT (N=43) were 51.0%, 31.9%, and 15.6%, respectively (P=0.001). Conclusion: HAT can reduce intraoperative blood loss and avoid allogeneic BT. Moreover, HAT may be uninfluential to postoperative complications, while, simultaneously improving survival for PHC.
Background: Symptomatic gallstones, functional dyspepsia(FD), and irritable bowel syndrome(IBS) have similar symptom pattern. This study determined the prevalence of FD/IBS in patients with gallstones and assessed the outcome of a cholecystectomy in terms of resolution of biliary colics and abdominal pain. Methods: A multicentre, prospective observational study was conducted. Adult patients with abdominal pain and ultrasonically confirmed gallstones were included. The presence of FD/IBS was assessed with the validated ROME-IV questionnaire. A biliary colic was defined by the ROME-III criteria. Pain-free was defined as an Izbicki Pain Score 10. Patients with and without FD/IBS at baseline were compared. Results: Between January 2018-April 2019, 401 patients (51.7 years, 76.3% females) were included. In total, 34.9% (140/401) of the patients with gallstones fulfilled the ROME-IV criteria for FD/IBS, and 64.1% (257/401) fulfilled the ROME-III criteria for biliary colic. Cholecystectomy rate was similar between the groups (73.8% in FD/IBSgroup vs. 75.5% in patients without FD/IBS, p=0.720). After follow-up of 24 weeks the biliary colic was resolved in 93.9% of patients with surgery (91.4% in FD/IBS-group vs. 95.1% in patients without FD/IBS, p=0.220). Pain-free after surgery was achieved in 56.8% of patients (40.7% in FD/ IBS-group vs. 64.4% in patients without FD/IBS, p< 0.001). Conclusion: One-third of the patients with gallstones fulfil criteria for FD and/or IBS. Cholecystectomy resolves biliary colics in 94% of patients, with similar outcome between patients with and without FD/IBS. However, painfree after surgery is significantly less in patients with FD/ IBS. This study partially explains the poor pain reduction after cholecystectomy.
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