Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

Hanif, Faisal; Ahmed, Zubir; Samie, Marion; Nassar, Ahmad H M

doi:10.1007/s00464-009-0809-4

Cited by 74 publications

(64 citation statements)

References 17 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

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104

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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

Self Cite

104

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“…As regards missed CBD stones, surgeons who support routine use of IOC claim that asymptomatic CBD stones constitute about 10%, and up to 2% show no signs of the disease [29]. Moreover, IOC is mandatory if laparoscopic CBD exploration (LCBDE) is intended [30,31]. This could help to avoid the morbidity and mortality of ERCP [32].…”

Section: Discussionmentioning

confidence: 97%

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

et al. 2011

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“…Additionally, the abovementioned preoperative step of diagnosis could be outdated (an IOC is mandatory before LCBDE). Some surgeons with sufficient expertise in advanced laparoscopy have proposed LCBD as an excellent option for CCL [66,67] , but acceptance of such a technique in most hospitals is far off due to its steep learning curve, especially when a T-tube has to be used [68] .…”

Section: Concomitant Laparoscopic Cholecystectomy and Common Bile Ducmentioning

confidence: 99%

“…LCBDE was confirmed to be superior compared to open surgery in terms of mortality and morbidity (but less effective for common bile duct clearance) since 2006 [77] . Theoretically, LCBDE minimizes the risks of post-ERCP complications [26][27][28][29] and the need for further anesthesia, with an excellent success rate of stone extraction (more than 90%) [67,77] . However, LCBDE remains limited to centers with advanced laparoscopic expertise [12] .…”

Section: Concomitant Laparoscopic Cholecystectomy and Common Bile Ducmentioning

confidence: 99%

Modern approach to cholecysto-choledocholithiasis

Bencini¹

2014

WJGE

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Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. The gold standard of care for gallbladder calculi and isolated common bile duct stones is represented by laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography, respectively, while a debate still exists regarding how to treat the two diseases at the same time. Many therapeutic options are also available when the two conditions are associated, including many different types of treatment, which local professionals often administer. The need to limit maximum discomfort and risks for the patients, combined with the economic pressure of reducing costs and utilizing resources, favors single-step procedures. However, a multitude of data fail to strongly demonstrate the superiority of any technique (including a two or multi-step approach), while rigorous clinical trials that include so many different types of treatment are still lacking, and it is most likely unrealistic to conduct them in the future. Therefore, the choice of the best management is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another.

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Laparoscopic transcystic bile duct exploration: the treatment of first choice for common bile duct stones

Abstract: The study advocates single-session laparoscopic cholecystectomy with transcystic CBD exploration as a feasible first choice treatment and the logical next step in the management of patients with CBD stones.

Cited by 74 publications

References 17 publications

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Major biliary complications in 2,714 cases of laparoscopic cholecystectomy without intraoperative cholangiography: a multicenter retrospective study

Modern approach to cholecysto-choledocholithiasis

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