Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery

Hamouda, A.; Goh, Wei Peng; Mahmud, Sajid; Khan, Mansoor; Nassar, Ahmad H M

doi:10.1007/s00464-006-9127-2

Cited by 33 publications

(27 citation statements)

References 21 publications

(20 reference statements)

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“…Higher than average rates of intra-operative cholangiography and CBD explorations were carried out, compared to normal surgical practice. Previous publications arising from this dataset and the methodology used for data collection have been published [12][13][14][15][16].…”

Section: Reference Datasetmentioning

confidence: 99%

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Hodson

et al. 2018

Surg Endosc

102

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Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall's tau for dichotomous variables, or Jonckheere-Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). ConclusionWe have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty.

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Section: Reference Datasetmentioning

confidence: 99%

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Hodson

et al. 2018

Surg Endosc

102

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“…However, laparoscopic bile duct revision is still performed by a minority of surgeons. Nassar et al [95] observed the development of CBD management over a period of 5 years in Scotland and noted that 18% of surgeons performed ERCP at the fi rst surveillance and 14% 5 years later. But the number of surgeons performing laparoscopic common bile duct exploration (LCBDE) also diminished from 4 to 3.8%.…”

Section: Current Status Of Laparoscopic Therapy Of Common Bile Duct Smentioning

confidence: 99%

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

Shamiyeh¹,

Wayand²

2005

Dig Dis

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Background: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. Methods: A Medline, PubMed, Cochrane search. Results: Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is ‘therapeutic splitting’ with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. Conclusion: The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.

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“…Retrospective case series observed an average time for RIOC of 12±9 minutes, a conversion rate of 6.9%, morbidity rate of 1.2%, and retained CBD of 4% (Millat, 1997); but a large recently published case series observed 27,2% of abnormal cholangiograms in elective LC and 94.1% of abnormal cholangiograms in patients admitted with biliary emergencies, concluding that in their experience 10% of abnormal cholangiograms occurred in patients without preoperative risk factors for bile duct stones (Hamouda, 2007), (Diagnostic studies 3b). Another retrospective case series evaluated LC without RIOC but including selective preoperative endoscopic cholangiography, and observed that only 0.5% of all patients had retained stones (Thornton, 2002); another one suggest that selective intraoperative cholangiography would miss a proportion of patients with choledocholithiasis (Tan, 2006).…”

Section: Routine Intraoperative Cholangiographymentioning

confidence: 99%

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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SUMMARY:The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.

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Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery

Cited by 33 publications

References 21 publications

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

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