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2.
Clinics (Sao Paulo) ; 76: e2189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33852651

RESUMO

OBJECTIVES: This study explored the effects of the timing of laparoscopic cholecystectomy (LC) after endoscopic retrograde cholangiopancreatography (ERCP) on liver function, bile biochemical indices, inflammatory reactions, and cholecysto-choledocholithiasis patient prognoses. METHODS: A total of 103 cholecysto-choledocholithiasis patients were stratified into control (CG; n=51; LC at 4-7 d after ERCP) and observation groups (OG; n=52; LC at 1-3 d after ERCP) using a random number table. RESULTS: The surgical time was shorter and intraoperative blood loss was less in OG than in CG, and the two groups were not statistically different in terms of time to the first passage of gas through anus, length of postoperative hospital stay, conversion rate to laparotomy, and stone-free rate. Four weeks after LC, alanine aminotransferase (ALT), total bilirubin (TBil), albumin (ALB), and glutamyl transpeptidase (GGT) levels declined in both groups, but the difference was not statistically significant. Three days after LC, total bile acid (TBA) levels increased, and cholesterol (CHO), unconjugated bilirubin (UCB), and TBiL levels were reduced in both groups, but were not statistically different (p>0.05). Three days after LC, interleukin (IL)-6, procalcitonin (PCT), and high-sensitivity C-reactive protein (hs-CRP) levels in the serum and bile increased in both groups and were lower in OG. The total incidence of perioperative complications was 1.92% in OG, which was lower than 15.69% in the CG. CONCLUSION: For cholecysto-choledocholithiasis patients, LC at 1-3 d after ERCP can shorten surgical times, reduce intraoperative blood loss, improve liver function and bile biochemistry, relieve inflammatory reactions, reduce complications, and improve prognoses.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Bile , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/cirurgia , Humanos , Tempo de Internação , Fígado , Prognóstico
4.
Medicine (Baltimore) ; 100(8): e24730, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663085

RESUMO

ABSTRACT: This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus.Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses.No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P < .05). There was no significant between-group difference in postoperative WBC values at 24 hours (P > .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ±â€Š190.01 vs 241.97 ±â€Š482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ±â€Š7.43 hours vs 37.56 ±â€Š9.91 hours, P < .001), hospital stay (8.32 ±â€Š1.55 days vs 4.56 ±â€Š1.38 days, P < .001), and hospitalization expenses (36800 ±â€Š11900 Yuan vs 28900 ±â€Š6500 Yuan, P = .016) were significantly lower in the experimental group.ERAS is a safe and effective perioperative nursing application in ERCP for treating choledocholithiasis. It can effectively accelerate patients' recovery and reduce the incidence of complications; therefore, it is worthy of being applied and promoted in clinical nursing.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/enfermagem , Coledocolitíase/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Adulto , Idoso , Idoso de 80 Anos ou mais , Amilases/sangue , Deambulação Precoce , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 100(11): e24735, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725940

RESUMO

BACKGROUND: So far, there was no consensus regarding balloon dilation time in endoscopic papillary balloon dilation (EPBD). Thus, we conducted a systematic review and meta-analysis to compare the stone removal and overall complication rates of dilation of short and long duration with EPBD. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library), Web of Science, EMBASE Databases, and PubMed were searched from their inception to December 1, 2019 for all articles regarding balloon dilation time in EPBD for removal of bile duct stones. The data were extracted and the methodology quality was assessed. Meta-analysis was performed using RevMan5.3 software. RESULTS: Four studies involving a total of 1553 patients were included, 918 in the short dilation group and 635 in the long dilation group. The results of meta-analysis showed that there was no significant difference between the 2 different dilation groups in the complete stone removal in randomized controlled trails (RCTs) group (P = .10) and non-RCTs group (P = 0.45), mechanical lithotripsy requirement (RCTs: P = .92; non-RCTs: P = .47), pancreatitis (RCTs: P = .48; non-RCTs: P = .45), bleeding (RCTs: P = .95; non-RCTs: P = .60), infection of biliary (RCTs: P = .58; non-RCTs: P = .29), perforation (RCTs: P = .32; non-RCTs: P = .37). CONCLUSION: This systematic review suggests that there no significant difference in the efficacy and safety of dilation of short and long duration for removal of bile duct stones with EPBD.


Assuntos
Cateterismo/métodos , Coledocolitíase/cirurgia , Dilatação/métodos , Litotripsia/métodos , Duração da Cirurgia , Idoso , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 100(3): e24104, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546017

RESUMO

BACKGROUND: Common bile duct stone (CBDS) is typically manifested with abdominal pain, chills, fever, and jaundice. Laparoscopic transcystic common bile duct exploration (LTCBDE) and endoscopic sphincterotomy (EST) are currently the main minimally invasive methods for the treatment of CBDS. However, there are few studies about the differences of medium and long-term complication after EST or LTCBDE. Therefore, we will conduct a meta-analysis and systematic review to systematically evaluate the difference of medium and long-term complications between EST and LTCBDE against CBDS. METHODS: Randomized controlled trials of EST or LTCBDE against CBDS will be searched in several English and Chinese databases with the following vocabularies: "laparoscopic transcystic common bile duct exploration," "endoscopic sphincterotomy," "choledocholithiasis," "common bile duct stone" until December, 2020. Two reviewers will independently conduct the literature extraction, risk of bias assessment, and statistical analysis. RESULTS AND CONCLUSIONS: The study will help to systematically evaluate the difference of medium and long-term complication between EST and LTCBDE against CBDS. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/5U7SA.


Assuntos
Coledocolitíase/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
7.
J Med Case Rep ; 15(1): 93, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33618756

RESUMO

BACKGROUND: Current management of choledocholithiasis entails the use of endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the common bile duct. A rare complication of this procedure is the impaction of the basket by a large stone, which necessitates lithotripsy. Here we report a case of an impacted basket during ERCP, which was managed by open surgery with a duodenotomy and the manual removal of the basket. CASE PRESENTATION: A 79-year-old Caucasian man was admitted to our department with yellowish discoloration of urine, skin and eyes. Abdominal ultrasonography showed a slightly thickened gallbladder, multiple gallbladder stones, dilated intrahepatic bile ducts and extrahepatic bile extending to 1.1 cm. A computed tomography (CT) scan demonstrated a stone in the common bile duct, which caused dilation of the biliary ducts. The patient was diagnosed with obstructive jaundice secondary to choledocholithiasis; and underwent an ERCP, a sphincterotomy and stone extraction. Four days following discharge, the patient was readmitted with jaundice, abdominal pain, vomiting and fever. He was diagnosed with ascending cholangitis and treated initially with antibiotics. A second ERCP revealed a dilated common bile duct and choledocholithiasis. Stone removal with a basket failed, as did mechanical lithotripsy. Finally, the wires of the basket were ruptured and stacked in the common bile duct together with the stone. During exploratory laparotomy, adhesiolysis, a Kocher maneuver of the duodenum and a subtotal cholecystectomy were performed. Choledochotomy did not succeed in removing the impacted wires together with the stone. Therefore, a duodenotomy and an extension of the sphincterotomy were performed, followed by high-pressure lavage of the common bile duct to remove additional small biliary stones. The choledochotomy and duodenotomy were closed by a one-layer suture, and a prophylactic gastroenterostomy was performed to prevent leakage from the common bile duct and the duodenum. The postoperative course was satisfactory. CONCLUSIONS: This is the first report in the literature of removal of an impacted Dormia basket through the papilla by performing a duodenotomy and an extension of the sphincterotomy, followed by gastroenterostomy.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Idoso , Colecistectomia Laparoscópica , Ducto Colédoco/cirurgia , Duodeno/cirurgia , Cálculos Biliares/cirurgia , Gastroenterostomia , Humanos , Masculino , Reoperação , Esfinterotomia Endoscópica , Instrumentos Cirúrgicos , Resultado do Tratamento
8.
Chirurgia (Bucur) ; 116(1): 42-50, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33638325

RESUMO

Background: Acute cholangitis is a systemic disease caused by acute inflammation and infection of the biliary tree and carries significant morbidity and mortality rates. The most common cause of acute cholangitis is choledocholithiasis, which can lead to an increased death rate in severe forms and in the absence of appropriate treatment. The clinical Charcot's triad is outdated due to low sensitivity and has been replaced with the criteria established by the Tokyo guidelines. The criteria of diagnosis are based on the presence of systemic inflammation, cholestasis and/or jaundice and biliary obstruction documented by imaging studies. Depending on the severity of the disease, treatment varies from antibiotic therapy to emergency endoscopic biliary drainage. In severe cases the first-line treatment is achieved by endoscopic retrograde cholangiopancreatography (ERCP). Method: To evaluate the effectiveness of urgent ERCP treatment in patients with acute cholangitis, a retrospective data analysis was performed of 185 patients that underwent endoscopic interventions between 2018 and September 2020, 74 patients of which have been identified with different grades of acute cholangitis. Results: The studied group consisted of 42 women (56.7%) and 32 men (43.3%), with a mean age of 62.2 (38-93) years. Obstructive choledocholithiasis was as the main cause of cholangitis (44 patients, 59.5%), with varying degrees of severity - grade I (41, 55.4%), grade II (22 patients, 29.7%) and grade III (11 patients, 14.8%). For cases with grade II and III of severity (33 patients, 44.5%), the endoscopic intervention took place in the first 12-24 hours after admission. Patients that had endoscopic dezobstruction in the first 12-24 hours had normal blood tests in 4.7 days (mean) and 5.8 days (mean) of hospital stay while patients that had dezobstruction more than 24 hours after admission had normal blood tests in 6.3 days (mean) and 7.6 days of hospital stay. Mortality was 5.4%, all 4 patients having grade III severity cholangitis. Conclusion: Patients that benefited from endoscopic biliary drainage in the first 24 hours after admission had a faster recovery, decreased duration of antibiotic therapy, decreased duration of hospital stay, lower morbidity and mortality rate compared to those that suffered the intervention more than 24 hours after admission.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangite , Coledocolitíase , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangite/etiologia , Colangite/cirurgia , Coledocolitíase/complicações , Coledocolitíase/cirurgia , Drenagem , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
12.
Acta Gastroenterol Belg ; 83(4): 577-584, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321014

RESUMO

Background and study aims: endoscopic retrograde cholangiopancreatography (ERCP) is essential when dealing in patients with choledocholithiasis. However, the proper extraction device selection is, often, a matter of the endoscopists' preference. We conducted a single center prospective randomized controlled study to access success rates for basket versus balloon catheters for small stones. Patient and methods: in our non-inferiority study, 180 patients with bile duct stones were randomized in a basket and a balloon catheter group. Inclusion criteria were fluoroscopically bile duct stones ≤10mm in diameter and a common bile duct diameter ≤15mm. The primary endpoint was the rate of complete bile duct clearance for each method. Secondary endpoints included time completed and amount of radiation dose recorded in each ERCP session, as well as any reported adverse events. Results: balloon was non-inferior to basket stone extraction (OR 3.35, 95% CI 1.12-10.05, p=0.031). Complete clearance was achieved in 69 out of 82 patients (84.1%) in the basket catheter group versus 79 out of 84 patients (94%) in the balloon catheter group (p=0.047) ; this seems to be especially true for patients with few stones and of small size (≤2 stones, p=0.043 and stone diameter ≤5mm, p=0.032). Complete stone clearance in the basket group patients took longer than that in the balloon group (4.52 and 4.06 min, respectively, p=0.015). Higher median radiation doses for stone clearance were recorded in the basket versus the balloon catheter group (1534.43 Gy versus 1245.45 Gy, p=0.023). Conclusions: our study showed that balloon was non-inferior to basket stone extraction.


Assuntos
Coledocolitíase , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/cirurgia , Humanos , Estudos Prospectivos , Método Simples-Cego , Esfinterotomia Endoscópica , Resultado do Tratamento
13.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 1001-1007, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177252

RESUMO

An 88-year-old patient had undergone endoscopic stenting for the treatment of acute cholangitis caused by choledocholithiasis. After a year and two months, he presented with cholangitis caused by common bile duct stones that formed a stent-stone complex. Another stent was observed adjacent to the old stent;however, the cholangitis relapsed in a short term. Thus, we planned to remove as many stones as possible. These stones were not free-floating and had affected the bile duct. Endoscopic mechanical lithotripsy was attempted;however, it failed. He was successfully treated using peroral cholangioscopy and electrohydraulic lithotripsy. After three months, he developed cholangitis because of the recurrence of choledocholithiasis. After removing as many stones as possible and performing endoscopic stenting, he was followed up as an outpatient. He had no symptoms for seven months after the procedure.


Assuntos
Coledocolitíase , Cálculos Biliares , Litotripsia , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Stents , Resultado do Tratamento
14.
Cir. Esp. (Ed. impr.) ; 98(9): 547-553, nov. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-198481

RESUMO

El abordaje laparoscópico es el método de elección para el tratamiento de la litiasis vesicular sintomática, y para muchos también lo es para la coledocolitiasis. Algunas situaciones especiales e infrecuentes en el tamaño, número y ubicación de los cálculos o en alteraciones de la anatomía biliar embriológicas o adquiridas pueden generar dificultades para la resolución de estas afecciones con técnicas laparoscópicas habituales. Para estas situaciones describimos 10 estrategias quirúrgicas de aplicación relativamente sencilla y que requieren de escasos recursos económicos, por lo que creemos que pueden adaptarse a la mayor parte de los centros quirúrgicos


Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers


Assuntos
Humanos , Laparoscopia/métodos , Vesícula Biliar/cirurgia , Coledocolitíase/cirurgia , Cistectomia/métodos , Ligadura/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(38): e22220, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957359

RESUMO

This study aimed to describe a novel puncture and discission with a needle (PDN) method facilitating laparoscopic common bile duct exploration (LCBDE).The clinical data of 81 patients with cholelithiasis or choledocholithiasis who underwent LCBDE with PDN between January, 2017 and December, 2017 were retrospectively analyzed. Time for puncture and discission of the bile duct, blood loss, postoperative complications (such as bile leakage, common bile duct [CBD] strictures, and recurrence of choledocholithiasis), and postoperative hospital stay were recorded to evaluate the safety of the method.PDN was performed in all 81 patients with a 100% surgical success rate. Surgery went smoothly. Neither mortality nor complications associated with PDN (portal vein injury or biliary leakage) were observed. The mean time for puncture and discission of the CBD was 2.4 minutes and the maximum blood loss was 100 mL. CBD strictures or recurrence of choledocholithiasis were not noted after 12 to 24 months of follow-up.LCBDE with PDN is a novel method and has the advantages of reliability, convenience, and efficiency without additional costs or complications.


Assuntos
Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Chirurgia (Bucur) ; 115(4): 526-529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876027

RESUMO

Surgical clip migration in the common bile duct with consecutive stone formation is a rare occurrence after laparoscopic cholecystectomy, less than 100 cases being reported so far. We report a case of a 55-year-old woman with obstructive jaundice due to bile duct stone formed around a migrated surgical clip 9 years after laparoscopic cholecystectomy. The patient presented with pain in the upper abdomen and jaundice. Abdominal ultrasound diagnosed dilation of the common bile duct and intrahepatic bile ducts. The diagnosis was confirmed by computed tomography which revealed a metal clip in the distal part of the common bile duct. The patient was managed successfully by endoscopic retrograde cholangiopancreatography (ERCP) and the surgical clip was retrieved using the Dormia basket. The exact mechanism of clip migration is not fully understood but may be explained by local inflammation and ineffective clipping. Although a rare occurrence, clip migration should not be excluded when considering the differential diagnosis of patients presenting with obstructive jaundice or cholangitis after laparoscopic cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips related complications but surgical common bile duct exploration may be necessary.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/etiologia , Ducto Colédoco/cirurgia , Migração de Corpo Estranho/etiologia , Icterícia Obstrutiva/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/instrumentação , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/diagnóstico por imagem , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Rev. esp. enferm. dig ; 112(8): 615-619, ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199966

RESUMO

INTRODUCCIÓN: la coledocolitiasis puede ser primaria (cálculos formados originalmente en la vía biliar) o secundaria (cálculos que han migrado de la vesícula biliar al colédoco). Nuestro objetivo fue estudiar las diferencias clínicas entre ambos tipos de coledocolitiasis en pacientes colecistectomizados. MATERIAL Y MÉTODOS: estudio comparativo y retrospectivo en el que se compararon pacientes colecistectomizados que presentaron coledocolitiasis. Se definió como coledocolitiasis residual o secundaria (grupo 1) la que apareció en los dos primeros años tras la colecistectomía y coledocolitiasis primaria (grupo 2) la que apareció después de los dos primeros años tras la colecistectomía. La coledocolitiasis se confirmó mediante colangiopancreatografía retrógrada endoscópica (CPRE) o cirugía. RESULTADOS: los pacientes con coledocolitiasis primaria (n = 14) tuvieron mayor edad (61,5 ± 20,3 vs. 74,4 ± 10,5 años; p = 0,049), mayor índice de masa corporal (IMC) (27,7 ± 4,3 vs. 31,6 ± 4,6 kg/m2; p = 0,043) y mayor diámetro de la vía biliar extrahepática (10,7 ± 2,7 vs. 14,7 ± 3,5 mm; p = 0,004) respecto a los pacientes con coledocolitiasis residual o secundaria (n = 11). Todos los pacientes fueron tratados mediante CPRE. No hubo diferencias entre los grupos 1 y 2 en cuanto a recidivas (36,2 % vs. 14,3 %; p = 0,350), intervalo libre de enfermedad (64,6 ± 30,9 vs. 52,2 ± 37,7 meses; p = 0,386) y supervivencia global (73,6 ± 32,4 vs. 54 ± 41,9 meses; p = 0,084). CONCLUSIONES: los pacientes con coledocolitiasis primaria presentan mayor edad, mayor IMC y mayor diámetro de la vía biliar respecto a los pacientes con coledocolitiasis residual o secundaria. La CPRE es una buena opción terapéutica para la resolución de ambos tipos de coledocolitiasis


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Coledocolitíase/cirurgia , Coledocolitíase/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Estimativa de Kaplan-Meier , Estudos Retrospectivos , Colecistectomia
20.
Ann R Coll Surg Engl ; 102(8): 598-600, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538107

RESUMO

INTRODUCTION: Common bile duct stones are present in 10% of patients with symptomatic gallstones. One-third of UK patients undergoing cholecystectomy will have preoperative ductal imaging, commonly with magnetic resonance cholangiopancreatography. Intraoperative laparoscopic ultrasound is a valid alternative but is not widely used. The primary aim of this study was to assess cost effectiveness of laparoscopic ultrasound compared with magnetic resonance cholangiopancreatography. MATERIALS AND METHODS: A prospective database of all patients undergoing laparoscopic cholecystectomy between 2015 and 2018 at a district general hospital was assessed. Inclusion criteria were all patients, emergency and elective, with symptomatic gallstones and suspicion of common bile duct stones (derangement of liver function tests with or without dilated common bile duct on preoperative ultrasound, or history of pancreatitis). Patients with known common bile duct stones (magnetic resonance cholangiopancreatography or failed endoscopic retrograde cholangiogram) were excluded. Ninety-day morbidity data were also collected. RESULTS: A total of 420 (334 elective and 86 emergency) patients were suspected to have common bile duct stones and were included in the study. The cost of a laparoscopic ultrasound was £183 per use. The cost of using the magnetic resonance cholangiopancreatography unit was £365 per use. Ten postoperative magnetic resonance cholangiopancreatographies were performed for inconclusive intraoperative imaging. The estimated cost saving was £74,650. Some 128 patients had common bile duct stones detected intraoperatively and treated. There was a false positive rate of 4.7%, and the false negative rate at 90 days was 0.7%. laparoscopic ultrasound use saved 129 bed days for emergency patients and 240 magnetic resonance cholangiopancreatography hours of magnetic resonance imaging. CONCLUSION: The use of laparoscopic ultrasound during laparoscopic cholecystectomy for the detection of common bile duct stone is safe, accurate and cost effective. Equipment and maintenance costs are quickly offset and hospital bed days can be saved with its use.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Cuidados Intraoperatórios/economia , Laparoscopia/economia , Ultrassonografia/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Análise Custo-Benefício , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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