Predictors of Failed Transcystic Laparoscopic Common Bile Duct Exploration: Analysis of Multicenter Integrated Health System Database

Al-Temimi, Mohammed; Rangarajan, Sriram; Chandrasekaran, Bindupriya; Kim, Edwin G.; Trujillo, Charles N.; Mousa, Asrai; Santos, David A.; Johna, Samir

doi:10.1089/lap.2018.0360

Cited by 11 publications

(22 citation statements)

References 15 publications

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“…Some studies have demonstrated that elevated bilirubin was associated with failure of CBD exploration, whereas others showed no significance of elevated bilirubin in predicting failure of the operation. 3,11,13 In this study, there was a similar proportion of patients who had an elevated preoperative bilirubin, 52.7% in patients with an unsuccessful LCBDE and 54% in patients with a successful LCBDE. Hence, these results suggest that even without preoperative ERCP and biliary decompression, LCBDE is an effective method of treating choledocholithiasis with high bilirubin level.…”

Section: Discussionsupporting

confidence: 61%

“…The relationship between number of CBD stones and the outcome of CBD exploration has been minimally explored in the literature and no association with success has previously been found. 3,13,19,20 Interestingly, despite the higher success rate, multiple stones were found to be associated with an increased risk of serious (Clavien-Dindo 3 or 4) complications in this study (OR: 3.79, 95% CI: 1.66-8.67, P = 0.002, Table 4). Negative outcomes have also been reported in the literature with multiple CBD stones found to be an independent risk factor for conversion to open access.…”

Section: Discussionmentioning

confidence: 49%

“…This was also in contrast to studies where nonbilirubin LFT did not show any significant association with the failure of operation. 3,11,12 Regarding age, studies have demonstrated that despite higher frequency of comorbidities and ASA grade, LCBDE could be safely performed on the elderly population and the postoperative outcomes such as length of stay, complications, and rate of open conversion were similar to their younger counterparts. 15,16 Given the larger cohort in this series, this may suggest a type 2 error in previous studies, however, the overall complication rate of the combined procedure remains low, particularly in the successful group.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, studies have shown that conversion to an open CBD exploration intraoperatively is associated with worse outcomes such as blood loss, postoperative complications and morbidity 10. Therefore, for centers where LCBDE is supported, it is important to study factors that would indicate success or failure of LCBDE to help surgeons preoperatively or intraoperatively exclude patients who are not suitable for the single staged approach 3,11–13…”

mentioning

confidence: 99%

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Factors That Predict the Success of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A 10-Year Study

Kao¹,

Seagar²,

Heathcock³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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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.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Factors That Predict the Success of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A 10-Year Study

Kao¹,

Seagar²,

Heathcock³

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…The rationale behind choosing ERCP over TCBDE is not clearly documented for the other patients. It may be influenced by the positive and negative predictors of TCBDE success as described above, but a prospective analysis of the decision‐making process is warranted to further understand the complexity behind approach selection 18,19 …”

Section: Discussionmentioning

confidence: 99%

Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5‐year tertiary centre experience

Teng

Izwan

et al. 2022

ANZ Journal of Surgery

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Background The incidence of choledocholithiasis on routine intraoperative cholangiogram (IOC) during cholecystectomy is approximately 12%. Cholecystectomy without IOC may lead to undiagnosed choledocholithiasis placing patients at risk of complications such as pancreatitis or cholangitis. This study aims to determine the incidence of choledocholithiasis intraoperatively as well as the associated risk factors and the methods of management. Methods A retrospective observational analysis of all laparoscopic cholecystectomies with IOC at the Gold Coast Hospital and Health Service from 1 January 2016 to 2 December 2021 was carried out. Patient demographics, operative data and cholangiogram findings were collected from electronic medical systems. Results A total of 3904 cholecystectomies were carried out over the study period. 3520 (90.1%) had an IOC, and 474 (13.4%) had positive IOC findings. 158 (33.3%) of the cases were managed intraoperatively with hyoscine butylbromide with or without intravenous glucagon followed by biliary tree flushing alone, 183 (38.6%) received transcystic bile duct exploration (TCBDE) with a success rate of 83% and 167 (35.2%) received endoscopic retrograde cholangiopancreatography (ERCP). Choledocholithiasis was incidental in 44 (9.28%) patients. Conclusion Incidental choledocholithiasis during routine IOC is not uncommon. Management predominantly includes intraoperative TCBDE or postoperatively via an ERCP. This study has not found reliable preoperative factors to predict choledocholithiasis based on preoperative clinical, radiological and biochemical factors. A small proportion of patients received preoperative endoscopic intervention, and the decision‐making process requires further investigation.

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Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta‐analysis

Hajibandeh

Sarma

et al. 2019

World j. surg.

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Objective To evaluate comparative outcomes of laparoscopic transcystic (TC) and transductal (TD) common bile duct (CBD) exploration. Methods We systematically searched MEDLINE, EMBASE, CINAHL, CENTRAL, the World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, ISRCTN Register, and bibliographic reference lists. CBD clearance rate, perioperative complications, and biliary complications were defined as the primary outcome parameters. Procedure time, length of hospital stay, conversion to open procedure were the secondary outcomes. Combined overall effect sizes were calculated using random-effects models. Results We identified 30 studies reporting a total of 4073 patients comparing outcomes of laparoscopic TC (n = 2176) and TD (N = 1897) CBD exploration. The TC approach was associated with significantly lower overall complications (RD: -0.07, P = 0.001), biliary complications (RD: -0.05, P = 0.0003), and blood loss (MD:-16.20, P = 0.02) compared to TD approach. Moreover, the TC approach significantly reduced the length of hospital stay (MD: -2.62, P \ 0.00001) and procedure time (MD: -12.73, P = 0.005). However, there was no significant difference in rate of CBD clearance (RD: 0.00, P = 0.77) and conversion to open procedure (RD: 0.00, P = 0.86) between two groups. Conclusions Laparoscopic TC CBD exploration is safe and reduces overall morbidity and biliary complications compared to the TD approach. Moreover, it is associated with significantly shorter length of hospital stay and procedure time. High-quality randomised trials may provide stronger evidence with respect to impact of the cystic duct/CBD diameter, number or size of CBD stones, or cystic duct anatomy on the comparative outcomes of TC and TD approaches.

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Predictors of Failed Transcystic Laparoscopic Common Bile Duct Exploration: Analysis of Multicenter Integrated Health System Database

Abstract: LCBDE is an effective and safe mean of clearing common bile duct stones at community hospitals of an integrated health system. Previously cited contraindications for TLCBDE are not absolute, but rather predictors of failure.

Cited by 11 publications

References 15 publications

Factors That Predict the Success of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A 10-Year Study

Factors That Predict the Success of Laparoscopic Common Bile Duct Exploration for Choledocholithiasis: A 10-Year Study

Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5‐year tertiary centre experience

Laparoscopic Transcystic Versus Transductal Common Bile Duct Exploration: A Systematic Review and Meta‐analysis

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