Elective laparoscopic cholecystectomy in the presence of common bile duct stent

Nair, Manojkumar S; Uzzaman, Mohammed Mohsin; Fafemi, Oladapo; Athow, Anna C.

doi:10.1007/s00464-010-1185-9

Cited by 15 publications

(10 citation statements)

References 28 publications

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“…Moreover, at long-term follow-up recurrent stones and cholangitis occur in 9–12% of cases after ERCP + ES, due to the subsequent modifications of the normal physiologic barrier and bactibilia [ 16 ]. Some studies have also reported an increased rate of difficult LC and higher conversion rates after ERCP, even if the previous endoscopic procedure had been only diagnostic [ 30 – 32 ]. As for the success rates, in the past several randomized multi-institutional trials have shown equivalence of single-stage versus the two-stage approach [ 5 , 11 , 33 ].…”

Section: Resultsmentioning

confidence: 99%

Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Quaresima

Balla

Guerrieri

et al. 2016

Gastroenterology Research and Practice

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Introduction. In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series. Methods. One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required. Results. Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy. Conclusions. Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique.

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Section: Resultsmentioning

confidence: 99%

Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Quaresima

Balla

Guerrieri

et al. 2016

Gastroenterology Research and Practice

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“…Among these periods, the development of CBDS between cholecystectomy and second ERC can be excluded because some reports have described that CBDS decreased in size and diameter, or disappeared in the majority of patients with biliary stent placement after EST [18, 19]. Moreover, it is unlikely for GS to enter the CBD during cholecystectomy because of small number of CBDS-associated complications reported after surgery [4, 12, 15, 16]. Thus, in the present study, recurrent CBDS is likely to have developed between first ERC and cholecystectomy, namely, during the waiting period for cholecystectomy in almost all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, stenting and subsequent surgical treatment resulted in a higher incidence of postoperative complications. Nair et al [15] suggested that the placement of a bile duct stent for long duration before elective LC affected the operation time, conversion rate, bile leak rate and length of hospital stay. In contrast, Lee et al [16] reported there were no surgical complications regardless of whether biliary stenting was performed, and that the insertion of a stent was not a predictor of conversion to OC or a long operative time.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Biliary Stenting Before Cholecystectomy in Patients With Gallstones and Common Bile Duct Stones

et al. 2019

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Background The usefulness of prophylactic biliary stenting for patients with common bile duct stones (CBDS) and gallstones (GS) to prevent recurrent biliary events after endoscopic sphincterotomy (EST) and CBDS extraction before elective cholecystectomy remains controversial. The aim of this study was to evaluate the risk of recurrent CBDS around the perioperative period and clarify its risk factors. Methods The clinical data of all patients who received prophylactic biliary stenting after EST for CBDS and later underwent cholecystectomy for GS followed by stent extraction in our institution were retrospectively reviewed. The numbers of residual CBDS at the end first and second endoscopic retrograde cholangiography (ERC) studies were compared. Univariate and multivariate analyses were performed using a logistic regression model to determine risk factors for recurrent CBDS in the perioperative period. Results Forty-two consecutive patients received prophylactic biliary stenting and subsequent cholecystectomy for GS. Three of these patients were excluded from this study because the number of residual stones was not confirmed. The median maximum CBDS diameter at second ERC was 0 mm (range, 0 - 10 mm); six patients had multiple CBDS (≥ 5). The number of CBDS at second ERC was increased in comparison to that at the first ERC in 15 patients (38.4%), and was unchanged or decreased in 24 patients. The median minimum cystic duct diameter was 4 mm (range, 1 - 8 mm). The median interval between first ERC and operation was 26 days (range, 2 - 131 days). The median interval between operation and second ERC was 41 days (range, 26 - 96 days). Laparoscopic cholecystectomy (LC) was performed in 38 patients, one of whom was converted from LC to open cholecystectomy. Postoperative complications (transient bacteremia) occurred in one patient. The cystic duct diameter was an independent risk factor for an increased number of CBDS at second ERC in the multivariate analysis (odds ratio 0.611 (95% confidence interval (0.398 - 0.939)), P = 0.03). Conclusion Recurrent CBDS around the perioperative period of cholecystectomy is not a rare complication after EST and the removal of CBDS with concomitant GS. Prophylactic biliary stenting is considered useful for preventing CBDS-associated complications, especially for patients in whom the cystic duct diameter is larger (≥ 5 mm).

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“…Regarding the ERC procedures, we compared the 2 groups according to the insertion of a biliary stent, and the timing of cholecystectomy after ERC. Nair et al 15 reported that the presence of a CBD stent was a risk factor for long operative duration and conversion to an open cholecystectomy. However, Verzhbitsky et al 16 showed no differences in the conversion rate in a stent insertion group and argued that having the stent in the CBD for a shorter period before surgery might eliminate the risk of conversion to an open operation.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for Long Operative Duration in Patients Undergoing Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Combined Choledochocystolithiasis

Lee¹,

Ha²,

Han³

et al. 2017

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Purpose:Choledochocystolithiasis and its associated complications such as cholangitis and pancreatitis are managed by endoscopic retrograde cholangiography (ERC), with endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). However, affected patients present with complex conditions linked to operative difficulties in performing LC. The aim of this study was to elucidate the predictive factors for a prolonged LC procedure following ERC for treating patients with choledochocystolithiasis.Materials and Methods:The medical records of 109 patients who underwent LC after ERC for choledochocystolithiasis from September 2012 to August 2014 were evaluated retrospectively. The cases were divided into long and short operative duration groups using a cutoff operative time of 90 minutes. We used univariate and multivariate analyses to investigate predictive factors associated with long operative duration according to clinical variables, ERC-related factors, and peak serum levels of laboratory test values between the initial presentation and LC (intervening period).Results:Seventeen patients needed >90 min to complete LC. The presence of acute cholecystitis, placement of percutaneous transhepatic gallbladder drainage, higher peak serum white blood cell count and levels of C-reactive protein (CRP), and lower peak serum levels of lipase during the intervening period were associated with prolonged operative duration. Multivariate analysis showed that the independent predictive factors for long operative duration were the presence of acute cholecystitis (hazard ratio, 5.418; P=0.016) and higher peak levels of CRP (hazard ratio, 1.077; P=0.022).Conclusion:When patients with choledochocystolithiasis are scheduled for LC after ERC, the presence of acute cholecystitis and high CRP levels during the intervening period could predict a protracted operation.

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Elective laparoscopic cholecystectomy in the presence of common bile duct stent

Abstract: We conclude that LC in the presence of CBD stents poses significant risk to patients, particularly if they are left in-situ for long periods of time. Caution should be exercised in stenting a CBD with an intact gallbladder, particularly in those awaiting cholecystectomy.

Cited by 15 publications

References 28 publications

Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Prophylactic Biliary Stenting Before Cholecystectomy in Patients With Gallstones and Common Bile Duct Stones

Predictive Factors for Long Operative Duration in Patients Undergoing Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiography for Combined Choledochocystolithiasis

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