Management of choledocholithiasis in an emergency cohort undergoing laparoscopic cholecystectomy: a single‐centre experience. Issue 7 (7th November 2013)

• Record Type: Journal Article
• Authors: Poh, Benjamin; Cashin, Paul; Bowers, Kaye; Ackermann, Travis; Tay, Yeng Kwang; Dhir, Arun; Croagh, Daniel
• Is Part Of: HPB. Volume 16:Issue 7(2014:Jul.)
• Page Start: 629
• Page End: 634
• Publication Date: 2013-11-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12187
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12187-sec-0001" sec-type="section"> <title>Introduction</title> <p>Minimally‐invasive options for the management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy include laparoscopic and endoscopic approaches. This study reviews the effectiveness of both approaches in an emergency setting.</p> </sec> <sec id="hpb12187-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective chart review was performed for a cohort of patients who underwent laparoscopic cholecystectomy. Outcomes assessed were duct clearance, the number of procedures performed (NPP), length of stay (LOS) and complication rate.</p> </sec> <sec id="hpb12187-sec-0003" sec-type="section"> <title>Results</title> <p>A total of 182 patients who underwent emergency laparoscopic cholecystectomies received intervention for choledocholithiasis. The duct clearance rate was lower in the laparoscopic group, 63% versus 86% (<italic>P</italic> = 0.001). However, the median NPP was also lesser in the laparoscopic group, 1 (interquartile range (IQR) 1–2) versus 2 (IQR 2–2) (<italic>P</italic> < 0.001), as was the median LOS, 5 days (IQR 3–8) versus 7 days (IQR 6–10) (<italic>P</italic> = 0.009). Forty‐eight laparoscopic endobiliary stents were attempted; stent deployment was successful in 37 patients. A larger proportion of patients with laparoscopic endobiliary stents had duct clearance by endoscopic retrograde cholangiopancreatography (ERCP) compared with those without, although this was not statistically significant (<italic>P</italic> = 0.208).</p> </sec> <sec id="hpb12187-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Laparoscopic clearance is not as effective as post‐operative ERCP in an emergency cohort, but is associated with fewer procedures required and a shorter inpatient stay. Thus, laparoscopic clearance may still be an attractive option for surgeons especially where conditions are favourable during an emergency laparoscopic cholecystectomy.</p> </sec> </abstract>