Is laparoscopic intraoperative cholangiogram a matter of routine?

Metcalfe, Matthew S.; Ong, Thao; Bruening, Martin; Iswariah, Harish; Wemyss‐Holden, Simon A.; Maddern, Guy J.

doi:10.1016/j.amjsurg.2003.12.047

Cited by 118 publications

(79 citation statements)

References 55 publications

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“…Intraoperative cholangiogram weren ot done in our study.The role of routine intraoperative cholangiogram is questionable and as elective policyi s probably warranted (15). Choledocholithiasis is unlikely if serum alkaline phosphate and bilirubin are normal and the calibreo ft he common bileduct is within normal limits in the ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study

2007

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Background and Aims: In some studies minilaparotomy cholecystectomy (MC) has been shown to be as good as laparoscopic cholecystectomy (LC) in the surgical treatment of cholecystolithiasis. To our knowledge, the MC operation is rarely considered as ad ay surgery procedure.Patients and Methods: Thirty electives ymptomatic non-complicated patients were included in the study during the end of the year 2004 to June 2005. The mean age of patients was 52 years (range 27-68), the mean body mass index 29 kg/m 2 (range 19-41). Gallstones were confirmed with ultrasound and the preoperative liver laboratory tests were normal in all patients. Afive (+/-2)centimetre-long incision was used avoiding to split the rectus abdominis muscle. All patients were re-evaluated four weeks postoperatively with the follow-up letter.Results: The average operating time was 51 minutes (range 30-105 minutes). Day surgery was possible in 25 cases(83%).Fivepatients (17%) stayedover nightatthe hospital. There were four (13%) conversions to conventional cholecystectomy.T he average postoperative sick leave was 16 days (range 14-30).T wo patients returned to hospital. One patienthad wound pain,but no complicationwas found, andthe patientwas notadmitted. One patient had aw ound infection and spent6d ays in the hospital. Twenty-nine (97%) patients were satisfied with the operation and were ready to recommend it for other patients.Conclusions: The results of this study support the suitability of MC as aday surgery procedure, but aprospective randomised trial is needed to evaluate the relative advantages of MC and LC.

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Section: Discussionmentioning

confidence: 99%

Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study

2007

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“…In 3% to 6% of the patients in whom CBD stones were detected, the stones were asymptomatic without preoperative indicators, negative abdominal ultrasound findings, or laboratory parameters [25,29,31]. It is believed that about 15% of these asymptomatic patients eventually will become symptomatic and require further interventional treatment [32]. Evaluation of the CBD for a planned cholecystectomy to decide on CBD exploration should be scheduled with a tight interval because the prevalence of CBD stones may change in time.…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

“…However, a postoperative ERCP may be unsuccessful in clearing the CBD, necessitating a second surgical procedure. Adopting a wait-and-see policy is associated with additional interventions and increased morbidity [32,[39][40][41]. On the other hand, a ''diagnostic'' ERCP for detection and potential clearance of CBD stones before surgery is not justified because 76% to 87% of patients have no CBD stones, and the costs and potential complications of such an invasive approach are considerable [25][26][27][28][29].…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

et al. 2009

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Background Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks.Conclusion From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.Keywords Acute biliary pancreatitis Á Cholecystectomy Á Endoscopic sphincterotomy Á ERCP Á Recurrent Acute biliary or gallstone pancreatitis (ABP) is an inflammatory condition of the pancreas induced by gallstones [1]. The initial treatment of ABP can be either conservative or interventional. The coexistence of cholangitis is an accepted indication for the performance of endoscopic retrograde cholangiopancreaticography (ERCP). However, whether this procedure is performed for patients with ABP depends on local expertise and guidelines, as is the decision to perform an endoscopic sphincterotomy (ES) [2][3][4][5].After patients have recovered from their first attack of ABP, most guidelines advocate a cholecystectomy to prevent a recurrent attack or other gallstone-related disorders such as symptomatic choledocholithiasis, cholecystitis, gallstone ileus, jaundice, and cholangitis [2][3][4][5]. ''Recurrent'' symptomatic choledocholithiasis after an initial attack of ABP may be preexisting common bile duct (CBD) stones not detected at the time of the primo episode or stones that migrated from the gallbladder into the CBD after initial stone clearance. Choledocholithiasis also may have developed newly within the bile duct after cholecystectomy.

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“…La realización de colangiografía intraoperatoria sistemática es discutida, prefiriéndose su indicación selectiva 20 . La LVBP puede ser tratada por vía laparoscópica 21 , pero sólo en centros con la experiencia y recursos suficientes, porque se asocia a mayor morbilidad que la cirugía abierta 22 .…”

Section: Discussionunclassified

¿Cuál es la prevalencia de litiasis de la vía biliar principal en pacientes con colecistolitiasis sintomática?

Claros¹,

Laguna²,

Ponce³

et al. 2007

Rev Chil Cir

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Is laparoscopic intraoperative cholangiogram a matter of routine?

Cited by 118 publications

References 55 publications

Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study

Minilaparotomy Cholecystectomy as a Day Surgery Procedure: A Prospective Clinical Pilot Study

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

¿Cuál es la prevalencia de litiasis de la vía biliar principal en pacientes con colecistolitiasis sintomática?

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