Gallstone cholangitis

Size: px
Start display at page:

Download "Gallstone cholangitis"

Transcription

1 Surg Endosc (2002) 16: DOI: /s t Springer-Verlag New York Inc es Gallstone cholangitis and Other Interventional Techniques A 10-year experience of combined endoscopic and laparoscopic treatment L. Sarli, D. Iusco, G. Sgobba, L. Roncoroni Department of Surgery, Institute of General Surgery and Surgical Therapy, University of Parma, School of Medicine, 14 Via Giamsci, Parma, Italy Received: 16 July 2001/Accepted in final form: 8 November 2001/Online publication: 5 March 2002 Abstract Background." To date, no procedure has yet been identified as the gold standard for the treatment of gallstone cholangitis in the laparoscopic era. Methods: The data of 109 consecutive patients with acute cholangitis were prospectively entered into a computerized database. All patients were managed according to a standard protocol. The main treatments were endoscopic retrograde cholangiography (ERC) combined with endoscopic sphincterotomy (ES), followed by interval laparoscopic cholecystectomy (LC). Patients in whom ERC or endoscopic stone clearance failed were managed by emergency open common bile duct exploration. LC was performed with a standardized four-cannula technique. The mean duration of surgery, conversion rate, and postoperative outcome of these patients were evaluated. Results." ERC was successful in 103 patients (94.5%). In five of these patients (4.8%), no bile duct stones were found. The 98 patients (95.2%) with common bile duct stones were referred for ES. The bile duct stones were successfully removed after ES in 93 cases (94.9%). The overall failure rate of ERC and ES for choledocholithiasis was 10.1%. Self-limiting pancreatitis occurred in four patients (4.3%). Overall, two of the 109 patients died (1.8%). After ES, 81 patients underwent LC. LC was performed successfully in 74 patients (91.3%). Conversion to open surgery was required in seven patients (8.7%). The morbidity rate after cholecystectomy was 7.4%; the morbidity rate after open bile duct exploration was 36.4% (p<0.05). Fifteen patients were managed conservatively after initial endoscopic management of their cholangitis. The overall incidence of recurrent biliary symptoms was significantly higher among patients with gallbladder in place than for patients who underwent cholecystectomy (38.5% vs 1.5%, p <0.001). Correspondence to: L. Sarli Conclusions: ES followed by LC is a safe and effective approach for the management of gallstone cholangitis; cholecystectomy should be performed in patients with gallstone cholangitis unless the operative risk is extremely high. These high operative risk patients and those who refuse surgery after ES should be warned that they are at high risk for recurrent biliary symptoms. Key words: Gallstone cholangitis -- Common bile duct stones -- Endoscopic retrograde cholangiography -- Endoscopic sphincterotomy -- Laparoscopic cholecystectomy In Western populations, acute cholangitis occurs in 6-9% of patients affected by gallstone disease [12]. For many years, open exploration and clearance of the bile duct was the standard treatment, and the mortality rate ran as high as 40% for patients with severe cholangitis [31, 32]. The introduction of endoscopic sphincterotomy (ES) lowered the mortality rate to between 0.4% and 7% [14, 15]; therefore, endoscopic management, followed by elective open surgery, became a standard approach [13]. With the rapid acceptance of laparoscopic cholecystectomy (LC), open surgery has been relegated to situations in which minimally invasive management has failed [24]. The management of choledocholithiasis has been influenced by the increasing success of minimally invasive methods. Most surgeons now try to avoid open duct exploration when bile duct stones coexist with gallbladder stones. Thus, some studies have focused on the efficacy and safety of laparoscopic bile duct exploration [6, 8, 11, 19, 28], whereas others have focused on the value of ES before, during, and after LC [2, 25]. However, few studies have specifically evaluated the efficacy of the mini-invasive approach for gallstone

2 976 Symptoms of gallstone cholangitis + Physical examination Urgent US Blood culture + IV antibiotics failed 4 ERC Failed ES ~ Successful Open Surgery ** For patients with unstable haemodynamic status or expected difficulty of stone removal, initial drainage was obtained by nasobi iax~, drainage or, in more recent years ( ), by the insertion of an endoorosthesis. LC Fig. I. Planned algorithm for the therapeutic management of patients affected by gallstone cholangitis. US, ultrasonography; IV, intravenous; ERC, endoscopic retrograde cholangiography; LC, laparoscopic cholecystectomy: ES, endoscopic sphincterotomy. cholangitis [22], and none have attempted to determine which of the different mini-invasive methods of management is the most effective for patients with cholangitis. The choice between these different methods is complex because of the multidisciplinary character of the treatments, the variation in availability from one center to another, and the varying experience of the surgeon in each of the available techniques of treatment. Since no randomized trials are available to prove which approach is preferable, it would be useful to examine the results that have been achieved with these different techniques. Therefore, we decided to analyze the prospectively collected results of our technical algorithm for the endoscopic-laparoscopic treatment of patients with gallstone cholangitis. Patients and methods During the 10-year period between January 1991 and January 2001, 109 consecutive patients with acute cholangitis due to gallstone disease were admitted to our institute. Patients with intrahepatic ductal stones or previous cholecystectomy were excluded from this study because the treatment of their disease was not included in the technical algorithm we wanted to analyze. There were 51 men (47%) and 58 women (53%). The mean age was 66.8 years (SD, 12.1; range, 28-94). The diagnosis of acute cholangitis was based on a combination of upper abdominal pain, jaundice, chills, and fever (temperature > 37.5~ [13]. Twenty nine patients (35%) had severe cholangitis, defined by the presence of septic shock, mental confusion, or persistent high fever despite antibiotic treatment [13]. The data of 109 consecutive patients with acute cholangitis were entered into a computerized database. Preoperative and intraoperative data were documented systematically and prospectively. Surgeons recorded the following information: clinical history, baseline characteristics, indications and results of perioperative evaluation, details of surgical technique and intraoperative findings, hospital course, and postoperative follow-up findings. All patients were managed according to a standard protocol. The algorithm for therapeutic management is shown in Fig. 1. Patients began fasting and were given intravenous fluid after admission. After routine blood tests, including blood culture, a broad-spectrum intravenous antibiotic was administered immediately after a clinical diagnosis of acute cholangitis was made. Urgent ultrasonography was performed to confirm the diagnosis. Patients underwent endoscopic retrograde cholangiography (ERC) combined with ES within 72 h of admission. For patients with severe cholangitis, emergency ERC was performed. All endoscopic procedures were performed at our hospital in the usual manner under pharyngeal anesthesia and intravenous sedation administered by two endoscopists with > 5 years of experience in diagnostic and therapeutic ERC. For patients with unstable hemodynamic status or expected difficulty of stone removal, initial drainage was obtained by nasobiliary drainage or--in more recent years ( )--by the insertion of an endoprosthesis using a polyethylene double pigtail catheter to control the sepsis, followed by ES and stone removal in an elective session. Otherwise, ES and stone removal were performed in the same session. Patients in whom ERC or endoscopic stone clearance failed were managed by emergency open common bile duct exploration. For patients in whom ES was successful, LC was offered within 1 week of the endoscopic procedures. High-risk patients, such as elderly patients with severe comorbid illnesses, and patients who refused surgery were managed conservatively with regular follow-up to monitor for any recurrent biliary symptoms. LC was performed with a standardized four-cannula technique [I0]. Low-molecular-weight heparin prophylaxis was given to all patients. Intraoperative cholangiography was performed whenever the surgeon was in doubt as to the biliary anatomy or bile duct clearance. A drain was used in all cases. The operating time was calculated from the start of incision until the last suture. The outcome of ERC, complications of ERC with ES and LC, and the rate of conversion from LC to an open procedure were recorded. Postoperative complications were evaluated according to a recently developed classification of surgical complications that has a severity scale comprising four grades [5] (Table 1). All patients were offered regular follow-up in the outpatient clinic. Patients were seen at intervals of 3 months in the 1st year, and then every 6 months to 1 year. Patients with recurrent biliary symptoms were readmitted investe for possible recurrent bile duct stones. Because of the possibility of biliary disease, patients who did not attend regular follow-ups were instructed to notify a physician from our team about any clinical symptoms or signs or any laboratory or imaging data that their family physician might have obtained. Moreover, for those who did not attend regular follow-ups, a telephone interview with the patient (or a relative if the patient had died) for any recurrent biliary symptoms was conducted by the principal investigator. The results of ERC with ES for retained stones were recorded. Statistical analyses were conducted with SAS procedures (SAS Program Institute, Cary, NC, USA). Continuous data were expressed as mean + standard deviation (SD). Fisher's exact test and the Wilcoxon test were used when appropriate. A p value < 0.05 was considered significant.

3 977 Table 1. Classification of surgical complications Grade I II iia lib IIi IV Description Non-life-threatening, no lasting disability, does not extend hospital stay to more than twice the mean hospitalization within the same patient group Potentially life-threatening, but without residual disability Does not require invasive procedure, but extends hospital stay to more than twice the mean hospitalization within the same patient group Requires invasive procedures Causes residuals disability Deaths due to complications Table 2. Comparison of results of 81 laparoscopic cholecystectomies (LC) after endoscopic sphincterotomy (ES) for cholangitis and results of 11 open common bile duct explorations (CBDE) according to the severity of cholangitis (severe, nonsevere) ES + LC (81) (n = 81) Open CBDE (n = I1) Mean age (yr SD) % ASA score III/IV 38% 73% Severe (n = 24) Nonsevere (n = 57) Severe (n = 3) Nonsevere (n = 8) Postoperative outcome Uncomplicated 87.5% 94.7% 66.6% 62.5% Grade I complications 8.3% 3.6% 33.3% 25% Grade IIa complications % Grade IIb complications 4.2% % ES, endoscopic sphincterotomy; LC, laparoscopic cholecystectomy; CBDE, common bile duct exploration; SD, standard deviation; ASA, American Society of Anesthesiologists Results The 109 patients in the study were referred for preoperative ERC. Billroth II gastrectomy prevented cannulation of the papilla in six cases (5.5%). For these six patients, open bile duct exploration was considered necessary. Open duct exploration confirmed bile duct stones in all these patients. ERC was successful in 103 patients (94.5%). In five these patient (4.8%), no bile duct stones were found, presumably owing to spontaneous stone passage. The 98 patients (95.2%) with common bile duct stones were referred for ES. ES failed in five of these 98 patients (5.1%). In three cases, ES was not attempted because of the presence of a duodenal diverticulum. In one case, several endoscopic sessions were insufficient to obtain bile duct clearance; and in one case stone extraction failed because of ductal stone impact For these latter five patients, LC was cancelled and emergency open surgery with choledochotomy was performed. Clearance of the common bile duct was achieved in all patients who underwent open bile duct exploration. The overall failure rate of ERC and ES for choledocholithiasis was 10.1%. The bile duct stones were successfully removed after ES in 93 cases (94.9%). To achieve complete ductal clearance of stones, 11 patients needed repeated endoscopic sessions (median, three; range, two to four). In seven cases, bile duct decompression was achieved by nasobiliary drainage (three patients) or by temporary stenting (four patients). Subsequently, ES was performed in all seven cases. Self-limiting pancreatitis oc- curred in four patients after ES and stone extraction (4.3%). These patients needed supportive therapy alone; all of them underwent LC 1 week later and enjoyed an uncomplicated course. Overall, two of the 109 patients died (1.8%). Both deaths occurred in patients with persistent septic shock caused by severe cholangitis despite emergency ES with bile duct stone extraction. The mortality rate among patients with severe cholangitis was 6.8%, whereas the mortality rate for patients with not severe cholangitis was nil. After ES, 81 patients underwent LC. LC was performed successfully in 74 patients (91.3%). Mean duration of LC was 57 min (range, ). Conversion to open surgery was required in seven cases (8.7%) due to dense adhesions (five patients) or intraoperative bleeding (two patients). No patient underwent intraoperative cholangiography during LC. Morbidity rate after cholecystectomy was 5.3% for patients with the nonsevere form of cholangitis and 12.5% for patients with severe cholangitis; the overall morbidity rate after cholecystectomy was 7.4% (Table 2). A total of 11 patients underwent open common bile duct exploration, including the five who had emergency open surgery. The median operating time was 135 min (range, ). The morbidity rate was 36.4% (Table 2) (25% for patients with the nonsevere form of cholangitis and 33.3% for patients with severe cholangitis}--significantly higher than the 7.4% among the 81 patients who underwent laparoscopic surgery with or without conversion (p < 0.05). Altogether, 92 patients underwent definitive surgical treatment without any operative mortality. The mean +

4 978 Table 3. Follow-up status of patients with and without cholecystectomy Alive with no recurrent biliary symptoms 62 (88.6) Recurrent cholangitis 1 (1.4) Recurrent common bile duct stones 1 (1.4) Biliary colic Deaths from unrelated condition 7 (10) n.s., not significant Date given as n (%) With cholecystectomy (n = 70) Without cholecystectomy (n = 13) p value 3 (23.1) (15.4) n.s 3 (23.1) 0.0! 2 (15.4) (38.5) 0.05 SD age of these patients was years (range, 24-78). Fifteen patients, with a mean age of years (range, 69-94), were managed conservatively after initial endoscopic management of cholangitis. Six patients were considered fit for LC after ES and common bile duct clearance but refused surgical intervention. The other nine patients had severe comorbid illnesses; thus they were considered to be at high risk for surgery and were managed conservatively after the endoscopic management of their cholangitis. Follow-up data were available for 83 of the 107 patients who survived the initial cholangitis, including 70 patients who had undergone cholecystectomy and 13 patients with gallbladder in place. Forty-seven patients had regular follow-ups in the outpatient clinic. For the remaining 36, telephone interviews were successfully conducted. When the end of follow-up was taken as the patient's death, the last follow-up was 39 months (range, ). The follow-up duration in patients with and without cholecystectomy was similar (median, 37 and 40 months, respectively). The follow-up status among the 83 patients by the time of analysis is given in Table 3. The overall incidence of recurrent biliary symptoms was significantly higher among patients with gallbladder in place than among those who had had a cholecystectomy (38.5% vs 1.4%, p < 0.001). Recurrent cholangitis was associated with recurrent bile duct stones in all cases. The three patients with cholangitis and the patient with recurrent bile duct stones underwent successful endoscopic stone clearance. One patient subsequently agreed to LC and had an uneventful operation. Discussion The ERC-ES sequence has proved effective in the management of bile duct stones, and in the laparoscopic era many surgeons--including ourselves [23]--consider preoperative endoscopy followed by laparoscopy to be the best two-step approach to cholecystocholedocholithiasis [9]. This approach requires a preoperative diagnosis of bile duct stones. ERC had been proposed as the investigative method of preoperatively assessing the common bile duct; however, preoperative ERC should not be carried out routinely since, when thus applied, it is not cost-effective [I], most of the endoscopic cholangiograms prove to be normal [18], and the procedure is not without danger [20]. An appropriate balance must be struck to maintain a high yield of positive or thera- peutic ERC, avoid unnecessary ERC, and not miss bile duct stones, while also ensuring acceptably low rates of morbidity and mortality and containing costs. In conclusion, endoscopic assessment of the bile duct should be performed only in patients with a high risk of having bile duct stones. In agreement with other findings [20, 22, 27], our data show that patients with acute cholangitis are those who have a high risk of harboring bile duct stones. The aim of preoperative ERC and ES in patients affected by acute chotangitis due to choledocholithiasis is to quickly decompress the biliary tree to remove the cause of sepsis. In 1977, good results were already being obtained when endoscopic decompression was employed for the management of a particular form of cholangitis, known as "supurative cholangitis" [14], more recently, a randomized trial showed better results after endoscopic biliary drainage followed by definitive treatment than after surgical decompression [13]. An aggressive policy of early endoscopic biliary drainage resulted in a very low mortality rate [22]. On the other hand, delay in ERCP for patients with severe cholangitis resulted in increased mortality and morbidity [4]. Even authors who maintain that the surgical treatment of patients with common bile duct stones is to be preferred to endoscopic management followed by cholecystectomy agree that the endoscopic management of bile duct stones is a better course in patients with severe cholangitis [291. Preoperative ES was performed safely in our hands, and none of the patients in the present study had surgery for their complications. Our early morbidity rate of 4.5% is one of the lowest ever reported in the literature [17, 27]. Endoscopic biliary decompression in acute cholangitis can be obtained not only by ES with clearance of bile duct stones, but also by nasobiliary drainage with or without ES or by stent placement Some authors consider endoscopic nasobiliary drainage or stent placement for acute cholangitis to be safer than ES as an initial step [26], while others believe that elderly patients should undergo endoscopic biliary drainage without sphincterotomy [30]. Like other authors [22], we preferred to carry out ES in all cases because, in addition to the benifits of biliary drainage for control of sepsis, ES allows endoscopic bile duct stone removal and thus the removal of the cause of the disease. Only for patients with unstable hemodynamic status or expected difficulty of stone removal was ES postponed to a later date and

5 Table 4, Mean operating time, conversion rate, and postoperative outcomes for 1863 standard laparoscopic cholecystectomies for uncomplicated gallstones 979 Parameter Operating time (range) Conversion rate (%) Postoperative outcome Uncomplicated Grade I complications Grade IIa complications Grade lib complications Result 42 min (15-120) 63 (3.4) 95.5% 3.4% 0.5% 0.5% initial drainage obtained by nasobiliary drainage or the insertion of an endoprosthesis to control the sepsis. In accordance with the experience of others [21, 22], we recently decided to use an endoprosthesis because we found it effective for biliary drainage and more convenient than nasobiliary drainage. Although, in contrast to stenting, a nasobiliary catheter is easily flushed to prevent clogging, it can be pulled out by the patient, it causes irritation in the nose or throat, and it is cosmetically less appealing. If the stones are successfully cleared endoscopically, the patient simply proceeds to LC, and the need for surgical exploration of the common bile duct is obviated. In this way, patients suffering from an illness such as acute cholangitis, which can often be serious, can also benefit from the advantages now offered by mini-invasive treatments. Only patients in whom ERCP or endoscopic stone clearance failed were managed by emergency open common bile duct exploration. In our experience, LC performed after ES for acute cholangitis required 57 rain; this time is only 15 min longer than the time required to perform a standard LC (Table 4). Although it is relatively high compared with LC for uncomplicated gallstone disease (Table 4), the conversion rate of 8.6% is acceptable and similar to that reported in similar cases [22]. The main reason for conversion was dense adhesions around the Calot triangle as a result of previous cholangitis. The morbidity observed after interval LC was no different from the incidence observed after standard LC (Table 4); most of the complications in this series were grade 1 [5J--that is, non-life-threatening, with no lasting disability, and which do not extend the hospital stay to more than twice the mean length of time within the same patient group. Although there is little question that severe cholangitis is best managed by endoscopic drainage followed by surgery, it is clear whether this is the best approach for patients with mild cholangitis. For the treatment of cholecysto-choledocholithiasis, a growing number of surgeons advocate the combination of ES and LC with therapeutic flexible biliary endoscopy performed under general anesthesia immediately prior to or immediately after cholecystectomy for a single-session performance of the two techniques [3, 7, 25]. However, none of these reports specifically involved cases of acute cholangitis: thus, it is not possible to evaluate whether this approach is useful in these particular conditions. The results of the multicenter study reported by Cuschieri et al. [6] suggest that single-stage laparoscopic treatment is the best option for the treatment of coexisting gallstones and bile duct stones. Urgent laparoscopic common bile duct exploration for cholangitis has been reported [16], as has elective laparoscopic bile duct exploration in selected cholangitis patients with failed endoscopic stone clearance [22]. Although this technology appears promising, it is not readily available. At the few centers that have expertise and the technology required, a laparoscopic bile duct exploration can be carried out. Our center has had little experience with laparoscopic bile duct exploration because we started to perform it only in selected cases in 1997 [23]; consequently, we have always preferred to perform ES followed by LC in patients affected by acute cholangitis. Even patients with bile duct stones that cannot be extracted by endoscopic means were not selected for laparoscopic exploration of the bile duct because they were considered difficult cases. In fact, they underwent emergency surgery, and some of them had already undergone Billroth II gastrectomy. We believed that open bile duct exploration was safer in these cases. Whether ES followed by LC or laparoscopic common bile duct exploration is the better approach for mild gallstone cholangitis is a subject that needs to be addressed by future studies. Our long-term findings suggest that ES alone is insufficient to treat patients with gallstone cholangitis. Patients managed with ES alone had a significantly higher risk of recurrent biliary symptoms than those who underwent cholecystectomy. On the other hand, mortality due to causes unrelated to cholangitis was also higher in the group of patients managed with ES alone because this group included all high operative risk or elderly patients and those with severe comorbid illnesses. In conclusion, our study confirms that ES followed by LC is a safe and effective approach for the management of gallstone cholangitis; cholecystectomy should be performed in patients with gallstone cholangitis unless the operative risk is extremely high. These high operative risk patients and patients who refuse surgery after ES should be warned about the high risk of recurrent biliary symptoms. References 1, Abboud PA, Malet PF, Berlin JA, Staroscik R, Cabana MD, Clarke JR, Shea JA, Schwartz JS, Williams SV (1996) Predictors of common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointest Endosc 44:

6 Arregui ME, Davis CJ, Arkush AM, Nagan RF (1992) Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholothiasis. Surg Endosc 6: Basso N, Pizzuto G, Surgo D, Materia A, Silecchia G, Fantini A, Fiocca F, Trentino P (1999) Laparoscopic cholecystectomy and intraoperative endoscopic sphincterotomy in the treatment of cholecystocholedocholithiasis. Gastrointest Endoscl 50: Boender J, Nix GA, de Ridder MA, Dees J, Schutte HE, van Buuren HR, van Blankenstein M (1995) Endoscopic sphincterotomy and biliary drainage in patients with cholangitis due to common bile duct stones. Am J Gastroenterol 90: Clavien PA, Sanabria JR, Strasburg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111: Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro VM, Jakimowiz J, Visa J, et al (1999) EAES multi-center prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13: De Palma GD, Angrisani L, Lorenzo M, Di Matteo E, Catanzaro C, Persico G, Tesauro BJ (1996) Laparoscopic cholecystectomy, intraoperative ES and CBDS extraction for management of patients with cholecystocholedochotithiasis. Surg Endos I0: Dion YM, Ratelle R, Morin J, Gravel D (1994) Common bite duct exploration. Surg Laparosc Endosc 4: Dorenbusch NJ, Maglinte DDT, Micon LT, Graffis RA, Turner WW Jr (1995) Intravenous cholangiography and the management ofcholedocholithiasis prior to laparoscopic cholecystectomy. Surg Laparosc Endosc 5: Dubois F, Icard P, Berthelot G, Munoz A (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 21 l: Huang SM, Wu CW, Chau GY, Jwo SC, Lui WY, P'eng FK (1996) An alternative approach of choledocholithotomy via laparoscopic choledochotomy. Arch Surg 131: Joyce WP, Keane R, Burke GJ, Daly M, Drumm J, Egan TJ, Delaney PV (1991) Identification of bite duct stones in patients undergoing Iaparoscopic cholecystectomy. Br J Surg 78: Lai ECS, Mok FPT, Tan Esy, Lo CM, Fan ST (1992) Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 326: Leese T, Neoptolemos JP, Baker AR, Carr-Locke DL (1986) Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg 73: Leung JWC, Chung SCS, Sung JJY, Banez VP, Li AKC (1989) Urgent endoscopic drainage for acute suppurative cholangitis. Lancet l: Lo CM, Liu CL, Fan ST, Lai ECS, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227: Lorimer JW, Lauzon J, FairfuII-Smith RJ, Yelle JD (1997) Management of choledocholithiasis in the time of laparoscopic cholecystectomy. Am J Surg 174: 68-7t 18. Macintyre IM, Goulborne IA, Gollock JM, Greive DC (1988) Operative cholangiography; a study of observer variation. J R Coil Surg Edinb 33: Millat B, Fingerhut A, Deleuze A, Briandet H, Marrel E, de Seguin Soulier P (1995) Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic treatment of choledocholithiasis. Br J Surg 82: , Mills JL, Beck DE, Harford EJ (1985) Routine operative cholangiography. Surg Gynecol Obstet 161: Misra SP, Dwivedi M (1996) Bitiary endoprosthesis as an alternative to endoscopic nasobiliary drr.inage in patients with acute cholangitis. Endoscopy 28: Poon RT, Liu CL, Lo CM, Lam CM, Yuen WK, Yeung C, Fan ST, Wong J (2001) Management of gallstone cholangitis in the era of laparoscopic cholecystectomy. Arch Surg 136: Sarli L, Pietra N, Franz~ A, Colla G, Costi R, Gobbi S, Trivelli M (1999) Routine intravenous cholangiography, selective ERCP, and endoscopic treatment of bile duct stones before laparoscopic cholecystectomy. Gastrointest Endosc 50: Sarli L, Pietra N, Sansebastiano G, Cattaneo G, Costi R, Grattarola M, Peracchia A (1997) Reduced postoperative morbidity after elective laparoscopic cholecystectomy: a stratified matched case-control study. World J Surg 21: Sarli L, Sabadini G, Pietra N, Longinotti E, Carreras F, Peracchia A (1995) Laparoscopic cholecystectomy and endoscopic sphincterotomy under a single anaesthetic: a case report. Surg Laparosc Endosc 5: Sharma BC, Agarwal DK, Baijal SS, Saraswat VA, Choudhuri G, Naik SR (1997) Endoscopic management of acute calculous cholangitis. J Gastroenterol Hepatol 12: Siegel JH, Rodriguez R, Cohen SA, Kasmin FE, Cooperman AM (1994) Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series. Am J Gastroenterol 89:1142-I Stoker ME (1995) Common bile duct exploration in the era of laparoscopic surgery. Arch Surg 130i Suc B, Escat J, Cherqui D, Fourtanier G, Hay JM, Fingerhut A, Millat B (1998) Surgery vs endoscopy as primary treatment in symptomatic patients with suspected common bile duct stones: a multicenter randomized trial. French Association for Surgical Research. Arch Surg 133: Sugiyama M, Atomi Y (1997) Treatment of acute cholangitis due to choledocholithiasis in elderly and younger patients. Arch Surg 132: Thompson JE Jr, Tompkins RK, Longmire WP Jr (1982) Factors in management of acute cholangitis. Ann Surg 195: Welch J, Donaldson GA (t976) The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. Am J Surg 131:

ORIGINAL ARTICLE. Management of Gallstone Cholangitis in the Era of Laparoscopic Cholecystectomy

ORIGINAL ARTICLE. Management of Gallstone Cholangitis in the Era of Laparoscopic Cholecystectomy ORIGINAL ARTICLE Management of Gallstone Cholangitis in the Era of Laparoscopic Cholecystectomy Ronnie Tung-Ping Poon, MD, FRCS(Ed); Chi-Leung Liu, MD, FRCS(Ed); Chung-Mau Lo, MS, FRCS(Ed), FRACS; Chi-Ming

More information

Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy. TEAM 1 Janix M. De Guzman, MD Presentor

Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy. TEAM 1 Janix M. De Guzman, MD Presentor Endoscopic Retrograde Pancreatography and Laparoscopic Cholecystectomy TEAM 1 Janix M. De Guzman, MD Presentor Premise 40F Jaundice Abdominal pain US finding of gallstones with apparently normal common

More information

T-TUBE DRAINAGE VERSUS PRIMARY COMMON BILE DUCT CLOSURE AFTER OPEN CHOLEDOCHOTOMY

T-TUBE DRAINAGE VERSUS PRIMARY COMMON BILE DUCT CLOSURE AFTER OPEN CHOLEDOCHOTOMY T-TUBE DRAINAGE VERSUS PRIMARY COMMON BILE DUCT CLOSURE AFTER OPEN CHOLEDOCHOTOMY Khaled Ahmed El- Dabee, Abd Al-Lateif Ahmed, Mohamed Abdel Aziz Abdel Jawad, Taha Bahgat Salam, Ahmed Eisa Ahmed* and Saed

More information

Comparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study

Comparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study Original article: Comparison Between Primary Closure of Common Bile Duct and T- Tube Drainage After Open Choledocholithiasis: A Hospital Based Study Kali CharanBansal Principal Specialist (General surgery)

More information

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic versus Laparo-Endoscopic

Single-Session Treatment of Cholecysto-Choledocholithiasis: Totally Laparoscopic versus Laparo-Endoscopic Journal of Surgery 2017; 5(5): 72-78 http://www.sciencepublishinggroup.com/j/js doi: 10.11648/j.js.20170505.11 ISSN: 2330-0914 (Print); ISSN: 2330-0930 (Online) Single-Session Treatment of Cholecysto-Choledocholithiasis:

More information

Interval Laparoscopic Cholecystectomy

Interval Laparoscopic Cholecystectomy HPB Surgery, 2000, Vol. 11, pp. 319-323 Reprints available directly from the publisher Photocopying permitted by license only (C) 2000 OPA (Overseas Publishers Association) N.V. Published by license under

More information

A journey to improve treatment outcome of laparoscopic cholecystectomy Donkervoort, S.C.

A journey to improve treatment outcome of laparoscopic cholecystectomy Donkervoort, S.C. UvA-DARE (Digital Academic Repository) A journey to improve treatment outcome of laparoscopic cholecystectomy Donkervoort, S.C. Link to publication Citation for published version (APA): Donkervoort, S.

More information

Single-stage management with combined tri-endoscopic approach. approach for concomitant cholecystolithiasis and choledocholithiasis

Single-stage management with combined tri-endoscopic approach. approach for concomitant cholecystolithiasis and choledocholithiasis Surg Endosc (2016) 30:5615 5620 DOI 10.1007/s00464-016-4918-6 and Other Interventional Techniques ENDOLUMINAL SURGERY Single-stage management with combined tri-endoscopic approach for concomitant cholecystolithiasis

More information

LIVER, PANCREAS, AND BILIARY TRACT

LIVER, PANCREAS, AND BILIARY TRACT CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2012;10:1157 1161 LIVER, PANCREAS, AND BILIARY TRACT Delayed and Unsuccessful Endoscopic Retrograde Cholangiopancreatography Are Associated With Worse Outcomes

More information

ERCP / PTC Surgical Laparoscopic vs open Timing and order of approach

ERCP / PTC Surgical Laparoscopic vs open Timing and order of approach Choledocholithiasis Which Approach and When? Lygia Stewart, MD University of California, San Francisco 2010 Naffziger Post-Graduate Course Clinical Manifestations of Choledocholithiasis Asymptomatic (no

More information

THE CURRENT PLACE OF SHOCK-WAVE LITHOTRIPSY FOR BILE DUCT STONES. Department of Surgery AUSTRALIA

THE CURRENT PLACE OF SHOCK-WAVE LITHOTRIPSY FOR BILE DUCT STONES. Department of Surgery AUSTRALIA HPB INTERNATIONAL 217 assessment of a predictive scoring system, both in patients treated by modern techniques and in a less highly selected group of patients, and the authors indicate that such studies

More information

Laparoscopic Cholecystectomy: A Retrospective Study

Laparoscopic Cholecystectomy: A Retrospective Study Bahrain Medical Bulletin, Vol. 37, No. 3, September 2015 Laparoscopic Cholecystectomy: A Retrospective Study Abdullah Al-Mitwalli, LRCPI, LRCSI* Martin Corbally, MBBCh, BAO, MCh, FRCSI, FRCSEd, FRCS**

More information

Type of intervention Treatment. Economic study type Cost-effectiveness analysis.

Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A Record Status

More information

Laparoscopic Common Bile Duct Exploration: Our First 50 Cases

Laparoscopic Common Bile Duct Exploration: Our First 50 Cases 136 Common Bile Duct Exploration Ker-Kan Tan et al Original Article Common Bile Duct Exploration: Our First 50 Cases Ker-Kan Tan, 1 MBBS, MRCS (Edin), MMed (Surg), Vishalkumar Girishchandra Shelat, 1 MRCS

More information

Title: The best approach to treat concomitant gallstones and. Authors: Jesús García-Cano, Francisco Domper

Title: The best approach to treat concomitant gallstones and. Authors: Jesús García-Cano, Francisco Domper Title: The best approach to treat concomitant gallstones and common bile duct stones. Is ERCP still needed? Authors: Jesús García-Cano, Francisco Domper DOI: 10.17235/reed.2019.6226/2019 Link: PubMed (Epub

More information

Jie Tao, Zheng Wang, Xue Yang, Jie Hao, Yu Li, Qingguang Liu, Hao Sun

Jie Tao, Zheng Wang, Xue Yang, Jie Hao, Yu Li, Qingguang Liu, Hao Sun Int J Clin Exp Med 2016;9(3):6628-6634 www.ijcem.com /ISSN:1940-5901/IJCEM0016878 Original Article Treatment of acute cholangitis of severe type with different modes of biliary drainage under X-ray-free

More information

Per-operative conversion of laparoscopic cholecystectomy to open surgery: prospective study at JSS teaching hospital, Karnataka, India

Per-operative conversion of laparoscopic cholecystectomy to open surgery: prospective study at JSS teaching hospital, Karnataka, India International Surgery Journal Raza M et al. Int Surg J. 2017 Jan;4(1):81-85 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20163977

More information

Case Report Successful laparoscopic common bile duct exploration in a patient with previous Billroth II gastrectomy

Case Report Successful laparoscopic common bile duct exploration in a patient with previous Billroth II gastrectomy Int J Clin Exp Med 2017;10(3):5480-5485 www.ijcem.com /ISSN:1940-5901/IJCEM0033592 Case Report Successful laparoscopic common bile duct exploration in a patient with previous Billroth II gastrectomy Ming-Jie

More information

Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis

Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis The American Journal of Surgery (2010) 200, 483 488 Clinical Science Optimal timing of elective laparoscopic cholecystectomy after acute cholangitis and subsequent clearance of choledocholithiasis Vicky

More information

Setting The study setting was hospital. The economic analysis was carried out in California, USA.

Setting The study setting was hospital. The economic analysis was carried out in California, USA. Preoperative versus postoperative endoscopic retrograde cholangiopancreatography in mild to moderate gallstone pancreatitis: a prospective randomized trial Chang L, Lo S, Stabile B E, Lewis R J, Toosie

More information

Study of post cholecystectomy biliary leakage and its management

Study of post cholecystectomy biliary leakage and its management Original Research Article Study of post cholecystectomy biliary leakage and its management P. Krishna Kishore 1*, B. Manju Sruthi 2, G. Obulesu 3 1 Assistant Professor, Departmentment of General Surgery,

More information

Primary Closure Versus T-tube Drainage After Open Choledochotomy

Primary Closure Versus T-tube Drainage After Open Choledochotomy Original Article Primary Closure Versus T-tube Drainage After Open Choledochotomy M. Ambreen, A.R. Shaikh, A. Jamal, J.N. Qureshi, A.G. Dalwani and M.M. Memon, Department of Surgery, Liaquat University

More information

Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis Original Article Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis Pradhan S 1, Shah S 2, Maharjan S 2, Shah JN 3 1 2 2 3 Professor, Patan hospital Correspondence:

More information

Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria

Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria Ankit Chhoda

More information

Laparoscopic Cholecystectomy in Acute Cholecystitis :An Experience with 100 cases

Laparoscopic Cholecystectomy in Acute Cholecystitis :An Experience with 100 cases ORIGINALARTICLE Laparoscopic Cholecystectomy in Acute Cholecystitis :An Experience with 100 cases Rajni Bhardwaj, M.R.Attri, Shahnawaz Ahangar Abstract This study was undertaken to evaluate our experience

More information

Cholecystectomy rate following endoscopic biliary interventions

Cholecystectomy rate following endoscopic biliary interventions Original Article Brunei Int Med J. 2012; 8 (4): 166-172 Cholecystectomy rate following endoscopic biliary interventions Sky Lim 1, Lin Naing 1, Vui Heng Chong 2 1 Pengiran Anak Puteri Rashidah Sa adatul

More information

Trend towards primary closure following laparoscopic exploration of the common bile duct

Trend towards primary closure following laparoscopic exploration of the common bile duct The Royal College of Surgeons of England HEPATOBILIARY doi 10.1308/003588408X242295 Trend towards primary closure following laparoscopic exploration of the common bile duct M JAMEEL, B DARMAS, AL BAKER

More information

ORIGINAL ARTICLE. Larissa University Hospital, Larissa, Greece

ORIGINAL ARTICLE. Larissa University Hospital, Larissa, Greece ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-7 Laparoendoscopic rendezvous may be an effective alternative to a failed preoperative endoscopic retrograde cholangiopancreatography in patients

More information

Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones

Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones J Korean Surg Soc 2011;81:128-133 DOI: 10.4174/jkss.2011.81.2.128 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pissn 2233-7903 ㆍ eissn 2093-0488 Laparoscopic common bile duct exploration

More information

SURGERY? COMMON BILE DUCT STONES ERCP OR. Room 759. Maryland

SURGERY? COMMON BILE DUCT STONES ERCP OR. Room 759. Maryland HPB INTERNATIONAL 277 alter the natural history of the disease, and delay or prevent the development or cirrhosis. Data from our unit as well as others suggests that to be the case. The current series,

More information

ISSN X (Print) Research Article. *Corresponding author Jitendra Singh Yadav

ISSN X (Print) Research Article. *Corresponding author Jitendra Singh Yadav Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2014; 2(3B):966-970 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)

More information

Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy

Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy Nzenza et al. BMC Gastroenterology (2018) 18:39 https://doi.org/10.1186/s12876-018-0765-3 RESEARCH ARTICLE Open Access Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy

More information

Two-port needlescopic cholecystectomy: prospective study of 100 cases!"#$%&'()*+,-./0123

Two-port needlescopic cholecystectomy: prospective study of 100 cases!#$%&'()*+,-./0123 KW Lee C Poon K Leung DWH Lee CW Ko Key words: Cholecystectomy, laparoscopic; iber optics; Laparoscopes; iniaturization; Needles!!"#$%&'(!"!! Hong Kong ed J 2005;11:30-5 Department of Surgery, Tuen un

More information

Study of the degree of gall bladder wall thickness and its impact on outcomes following laparoscopic cholecystectomy in JSS Hospital

Study of the degree of gall bladder wall thickness and its impact on outcomes following laparoscopic cholecystectomy in JSS Hospital International Surgery Journal Chandra SBJ et al. Int Surg J. 2018 Apr;5(4):1417-1421 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20181122

More information

Gallstones & Other Biliary Disorders

Gallstones & Other Biliary Disorders Gallstones & Other Biliary Disorders Jason Smith MD DMI FRCS(Gen.Surg) Consultant General & Colorectal Surgeon Introduction Gallstones are found in 12% men and 24% women Prevalence increases with advancing

More information

Gallstones. Classification

Gallstones. Classification Gallstones Nariman Karanjia Tahir Ali Abstract Gallstones are extremely common in the UK and have a major effect on healthcare resources. Presentation depends on whether the stones occlude the cystic duct

More information

ORIGINAL ARTICLE. Prospective Randomized Trial of LC LCBDE vs ERCP/S LC for Common Bile Duct Stone Disease

ORIGINAL ARTICLE. Prospective Randomized Trial of LC LCBDE vs ERCP/S LC for Common Bile Duct Stone Disease ORIGINAL ARTICLE Prospective Randomized Trial of LC LCBDE vs ERCP/S LC for Common Bile Duct Stone Disease Stanley J. Rogers, MD; John P. Cello, MD; Jan K. Horn, MD; Allan E. Siperstein, MD; William P.

More information

The Importance of Intraoperative Cholangiography during Laparoscopic Cholecystectomy

The Importance of Intraoperative Cholangiography during Laparoscopic Cholecystectomy The Importance of Intraoperative Cholangiography during Laparoscopic Cholecystectomy Fatin R. Polat, MD, Ilker Abci, MD, Irfan Coskun, MD, Selman Uranues, MD ABSTRACT Laparoscopic cholecystectomy (LC)

More information

Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy

Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy Original Article 631 Risk Factors for Conversion to Open Surgery in Patients With Acute Cholecystitis Undergoing Interval Laparoscopic Cholecystectomy Kok-Ren Lim, 1 MRCS (Edin), Salleh Ibrahim, 1 FRCS

More information

ENDOSCOPIC TREATMENT OF A BILE DUCT

ENDOSCOPIC TREATMENT OF A BILE DUCT HPB Surgery, 1990, Vol. 3, pp. 67-71 Reprints available directly from the publisher Photocopying permitted by license only 1990 Harwood Academic Publishers GmbH Printed in the United Kingdom CASE REPORT

More information

Management of Gallstone Pancreatitis: Effects of Deviation from Clinical Guidelines

Management of Gallstone Pancreatitis: Effects of Deviation from Clinical Guidelines Management of Gallstone Pancreatitis: Effects of Deviation from Clinical Guidelines Kevin Sargen, Andrew N Kingsnorth Department of Surgery, Plymouth Postgraduate Medical School, Derriford Hospital. Plymouth.

More information

Making ERCP Easy: Tips From A Master

Making ERCP Easy: Tips From A Master Making ERCP Easy: Tips From A Master Raj J. Shah, M.D., FASGE Associate Professor of Medicine University of Colorado School of Medicine Co-Director, Endoscopy Director, Pancreaticobiliary Endoscopy Services

More information

CHOLANGIOGRAPHY IN PATIENTS WITH SUSPECTED DUCT STONES

CHOLANGIOGRAPHY IN PATIENTS WITH SUSPECTED DUCT STONES SAFETY AND OUTCOME OF SELECTIVE INTRA-OPERATIVE CHOLANGIOGRAPHY IN PATIENTS WITH SUSPECTED DUCT STONES Ihab Kadry, Mahmoud Reda, Hesham Ahmed and Mohamed ZaaZou. Department Of General Surgery Misr University

More information

Early management of complicated gallstones and acute pancreatitis

Early management of complicated gallstones and acute pancreatitis Early management of complicated gallstones and acute pancreatitis A/Prof Richard Cade George Kalogeropoulos ( Fellow) HPB/Upper GI Unit Eastern Health, Melbourne biliary colic/acute cholecystitis common

More information

THE INTERVENTIONAL RADIOLOGIST CHRISTIAAN VAN DER LEIJ, MD. EBIR. INTERVENTIONAL RADIOLOGY MAASTRICHT UMC+

THE INTERVENTIONAL RADIOLOGIST CHRISTIAAN VAN DER LEIJ, MD. EBIR. INTERVENTIONAL RADIOLOGY MAASTRICHT UMC+ THE INTERVENTIONAL RADIOLOGIST CHRISTIAAN, MD. EBIR. INTERVENTIONAL RADIOLOGY MAASTRICHT UMC+ DISCLOSURES None 78 Y/O FEMALE Painful RUQ Fever Lab: Raised Leukocytes/CRP CHOLECYSTITIS 3-9% patients ER

More information

Bile Duct Injury during Lap Chole. Bile Duct Injury during cholecystectomy TOPICS. 1. Prevalence, mechanisms, prevention and diagnosis

Bile Duct Injury during Lap Chole. Bile Duct Injury during cholecystectomy TOPICS. 1. Prevalence, mechanisms, prevention and diagnosis Bile Duct Injury during cholecystectomy Catherine HUBERT Jean-Fran François GIGOT Benoît t NAVEZ Division of Hepato-Biliary Biliary-Pancreatic Surgery Department of Abdominal Surgery and Transplantation

More information

complication rates and/or incomplete clearance with need of intervention (ie, unfavorable outcomes).

complication rates and/or incomplete clearance with need of intervention (ie, unfavorable outcomes). Research Original Investigation Natural Course vs Interventions to Clear Common Bile Duct Stones Data From the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography

More information

Naoyuki Toyota, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Fumihiko Miura, and Keita Wada

Naoyuki Toyota, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Fumihiko Miura, and Keita Wada J Hepatobiliary Pancreat Surg (2006) 13:80 85 DOI 10.1007/s00534-005-1062-4 Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operator s aim

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research   ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Comparative Study between Laparoscopic and Open Cholecystectomy for Dr. B. Hemasankararao 1,

More information

Comparison between primary closure and T-tube drainage after open choledocotomy

Comparison between primary closure and T-tube drainage after open choledocotomy ISSN: 2203-1413 Vol.03 No.04 Comparison between primary closure and T-tube drainage after open choledocotomy Alireza Barband 1, Farzad Kakaei 1, Morteza Ghojazadeh 2, Abdolhamid Chavoshi Khamneh 1*, Morteza

More information

Safety of endoscopic retrograde cholangiopancreatography in patients 80 years of age and older

Safety of endoscopic retrograde cholangiopancreatography in patients 80 years of age and older Original paper Safety of endoscopic retrograde cholangiopancreatography in patients 80 years of age and older Baydar Behlül 1, Serin Ayfer 2, Vatansever Sezgin 3, Kandemir Altay 3, Çelik Mustafa 3, Çekiç

More information

Appendix A: Summary of evidence from surveillance

Appendix A: Summary of evidence from surveillance Appendix A: Summary of evidence from surveillance 2018 surveillance of Gallstone disease: diagnosis and management (2014) NICE guideline CG188 Summary of evidence from surveillance Studies identified in

More information

Research Article Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low Risk of Common Duct Stones: Can It Be Beneficial?

Research Article Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low Risk of Common Duct Stones: Can It Be Beneficial? Hindawi Minimally Invasive Surgery Volume 2017, Article ID 9814389, 5 pages https://doi.org/10.1155/2017/9814389 Research Article Routine Cysticotomy and Flushing of the Cystic Duct in Patients with Low

More information

Evaluation of Complications Occurring in Patients Undergoing Laparoscopic Cholecystectomy: An Institutional Based Study

Evaluation of Complications Occurring in Patients Undergoing Laparoscopic Cholecystectomy: An Institutional Based Study Original article: Evaluation of Complications Occurring in Patients Undergoing Laparoscopic Cholecystectomy: An Institutional Based Study Sudhir Tyagi 1, Sanjeev Kumar 2* 1 Assistant Professor, 2* Associate

More information

The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease

The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease Ann R Coll Surg Engl 1994; 76: 42-46 The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease Ara Darzi FRCSI Registrar in Surgery

More information

Subtotal cholecystectomy for complicated acute cholecystitis: a multicenter prospective observational study

Subtotal cholecystectomy for complicated acute cholecystitis: a multicenter prospective observational study Study title Subtotal cholecystectomy for complicated acute cholecystitis: a multicenter prospective observational study Primary Investigator: Kazuhide Matsushima, MD Co-Primary investigator: Zachary Warriner,

More information

Determination of optimal operation time for the management of acute cholecystitis: a clinical trial

Determination of optimal operation time for the management of acute cholecystitis: a clinical trial Original paper Determination of optimal operation time for the management of acute cholecystitis: a clinical trial Erkan Oymaci 1, Ahmet Deniz Ucar 1, Savas Yakan 1, Erdem Baris Carti 1, Ali Coskun 1,

More information

Endoscopic management of postoperative bile duct injuries: a single center experience.

Endoscopic management of postoperative bile duct injuries: a single center experience. 1- Endoscopic management of postoperative bile duct injuries: a single center experience. BACKGROUND/AIM: Biliary endoscopic procedures may be less invasive than surgery for management of postoperative

More information

Principles of ERCP: papilla cannulation, indications/contraindications and risks. Dr. med. Henrik Csaba Horváth PhD

Principles of ERCP: papilla cannulation, indications/contraindications and risks. Dr. med. Henrik Csaba Horváth PhD Principles of ERCP: papilla cannulation, indications/contraindications and risks Dr. med. Henrik Csaba Horváth PhD Evolution of ERCP 1968. 1970s ECPG Endoscopic CholangioPancreatoGraphy Japan 1974 Biliary

More information

Downloaded from jssu.ssu.ac.ir at 13:10 IRST on Saturday October 28th 2017

Downloaded from jssu.ssu.ac.ir at 13:10 IRST on Saturday October 28th 2017 Journal of Shahid Sadoughi University of Medical Sciences Vol. 21, No. 5, Nov-Dec 2013 Pages: 675-681 1392 5 21 675-681 : 3 2* 1 1392/8/ : -1-2 -3 1391/8/24 : (). :. 1390 200 :.. SPSS (%0/5) 200 (8%) (%9/5)19

More information

Greater Manchester EUR Policy Statement on: Asymptomatic Gallstones GM Ref: GM061 Version: 0.2 (21 November 2018)

Greater Manchester EUR Policy Statement on: Asymptomatic Gallstones GM Ref: GM061 Version: 0.2 (21 November 2018) Greater Manchester EUR Policy Statement on: Asymptomatic Gallstones GM Ref: GM061 Version: 0.2 (21 November 2018) Commissioning Statement Asymptomatic Gallstones Policy Exclusions (Alternative commissioning

More information

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005

Lutheran Medical Center. Daniel H. Hunt, M.D. June 10 th, 2005 Lutheran Medical Center Daniel H. Hunt, M.D. June 10 th, 2005 History xx y.o. pt with primary CBD stones s/p ERCP xx months earlier for attempted stone extraction resulting in post ERCP pancreatitis. Patient

More information

ERCP and EUS: What s New and What Should We Do?

ERCP and EUS: What s New and What Should We Do? ERCP and EUS: What s New and What Should We Do? Rajesh N. Keswani, MD Associate Professor of Medicine Division of Gastroenterology Northwestern University Feinberg School of Medicine EUS/ERCP in 2015 THE

More information

Percutaneous Removal of Biliary Stone from Anomalous Right Hepatic Duct

Percutaneous Removal of Biliary Stone from Anomalous Right Hepatic Duct Percutaneous Removal of Biliary Stone from Anomalous Right Hepatic Duct Pages with reference to book, From 94 To 96 Tanveer ul Haq, Mohammed Younus Sheikh, Changes Khan Jadun, M.N. Ahmad, Yousuf H. Husen

More information

Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 26-30

Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 26-30 Kathmandu University Medical Journal (29), Vol. 7, No. 1, Issue 25, 2-3 Original Article Evaluation of predictive factors for conversion of laparoscopic cholecystectomy Gabriel R, Kumar S, Shrestha A Department

More information

Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre!"#$%&'()*+,-./0n T Q!

Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre!#$%&'()*+,-./0n T Q! ORIGINAL ARTICLE CN Tang KK Tsui JPY Ha WT Siu MKW Li Key words: Cholangiopancreatography, endoscopic retrograde; Cholecystectomy, laparoscopic; Common bile duct/surgery; Gallstones/surgery; Sphincterotomy,

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE Appendix B: Scope NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE Post publication note: The title of this guideline changed during development. This scope was published before the guideline

More information

Guidelines for Laparoscopic CBD Exploration

Guidelines for Laparoscopic CBD Exploration Guidelines for Laparoscopic CBD Exploration INDICATIONS Since the 1992 National Institutes of Health Consensus Development Conference Statement on Gallstones and Laparoscopic Cholecystectomy the indications

More information

Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk?

Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk? Surg Endosc (2007) 21: 41 47 DOI: 10.1007/s00464-006-0169-2 Ó Springer Science+Business Media, Inc. 2006 Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in

More information

No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study

No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study Original article Annals of Gastroenterology (2013) 26, 1-6 No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study Rachel M. Gomes

More information

Is cholecystectomy necessary after endoscopic treatment of bile duct stones in patients older than 80 years of age?

Is cholecystectomy necessary after endoscopic treatment of bile duct stones in patients older than 80 years of age? 九州大学学術情報リポジトリ Kyushu University Institutional Repository Is cholecystectomy necessary after endoscopic treatment of bile duct stones in patients older than 80 years of age? Yasui, Takaharu Department of

More information

Management of Gallbladder Disease

Management of Gallbladder Disease Management of Gallbladder Disease Steven B. Johnson, MD, FACS, FCCM Professor and Chairman, Department of Surgery Program Director, Phoenix Integrated Surgical Residency University of Arizona College of

More information

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell

Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell Cardiovasc Intervent Radiol (2015) 38:964 970 DOI 10.1007/s00270-014-1014-y CLINICAL INVESTIGATION NON-VASCULAR INTERVENTIONS Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the

More information

The Present Scenario of Cholecystectomy

The Present Scenario of Cholecystectomy IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 5 Ver. III (May. 2016), PP 71-75 www.iosrjournals.org The Present Scenario of Cholecystectomy

More information

ROUTINE VERSUS SELECTIVE INTRA-OPERATIVE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY

ROUTINE VERSUS SELECTIVE INTRA-OPERATIVE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY ROUTINE VERSUS SELECTIVE INTRA-OPERATIVE CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY Ghazalah Bassam A. Abstract Background: Undergoing Intraoperative cholangiography during laparoscopic cholecystectomy

More information

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly

Percutaneous cholecystostomy for the treatment of acute cholecystitis in the critically ill and elderly ORIGINAL ARTICLE Key words: Cholecystectomy; Cholecystostomy!!"#!" JCM Li DWH Lee CW Lai ACN Li DW Chu ACW Chan Hong Kong Med J 2004;10:389-93 North District Hospital, New Territories East Cluster, 9 Po

More information

ORIGINAL ARTICLE. Early Laparoscopic Cholecystectomy Is the Preferred Management of Acute Cholecystitis

ORIGINAL ARTICLE. Early Laparoscopic Cholecystectomy Is the Preferred Management of Acute Cholecystitis ORIGINAL ARTICLE Early Laparoscopic Cholecystectomy Is the Preferred Management of Acute Cholecystitis Robert A. Casillas, MD; Sara Yegiyants, MD; J. Craig Collins, MD, MBA Hypothesis: Early laparoscopic

More information

Laparoscopic Common Bile Duct Exploration : A Feasible Option for Choledocholithiasis in Patients with Previous Gastrectomy

Laparoscopic Common Bile Duct Exploration : A Feasible Option for Choledocholithiasis in Patients with Previous Gastrectomy ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2016;19(4):130-134 Journal of Minimally Invasive Surgery Laparoscopic Common Bile Duct Exploration : A Feasible Option for Choledocholithiasis

More information

What can you expect after your ERCP?

What can you expect after your ERCP? ERCP Explained and respond to bed rest, pain relief and fasting to rest the gut with the patient needing to stay in hospital for only a few days. Some patients develop severe pancreatitis and may require

More information

Routine Testing of Liver Function Before and After Elective Laparoscopic Cholecystectomy: Is It Necessary?

Routine Testing of Liver Function Before and After Elective Laparoscopic Cholecystectomy: Is It Necessary? Routine Testing of Liver Function Before and After Elective Laparoscopic Cholecystectomy: Is It Necessary? Nasir Zaheer Ahmad, FRCSI SCIENTIFIC PAPER ABSTRACT Background and Objectives: Liver function

More information

The campaign on laboratory: focus on Gallstone Disease and ERCP

The campaign on laboratory: focus on Gallstone Disease and ERCP The campaign on laboratory: focus on Gallstone Disease and ERCP Mauro Giuliani, MD, Specialist in Visceral Surgery, Vice Head Physician, Surgical Ward, Ospedale Regionale di Locarno Alberto Fasoli, MD,

More information

Surveillance proposal consultation document

Surveillance proposal consultation document Surveillance proposal consultation document 2018 surveillance of Gallstone disease: diagnosis and management (NICE guideline CG188) Proposed surveillance decision We propose to not update the NICE guideline

More information

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010

Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Management of biliary injury after laparoscopic cholecystectomy N. Dayes Kings County Hospital Center & Long Island College Hospital 8/19/2010 Case Presentation 30 y.o. woman with 2 weeks of RUQ abdominal

More information

SAGES GUIDELINES FOR THE CLINICAL APPLICATION OF LAPAROSCOPIC BILIARY TRACT SURGERY

SAGES GUIDELINES FOR THE CLINICAL APPLICATION OF LAPAROSCOPIC BILIARY TRACT SURGERY Practice/Clinical Guidelines published on: 01/2010 by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) SAGES GUIDELINES FOR THE CLINICAL APPLICATION OF LAPAROSCOPIC BILIARY TRACT

More information

Mauro Podda 1 Francesco Maria Polignano. Michael Samuel James Wilson 1 Christoph Kulli

Mauro Podda 1 Francesco Maria Polignano. Michael Samuel James Wilson 1 Christoph Kulli Surg Endosc (2016) 30:845 861 DOI 10.1007/s00464-015-4303-x and Other Interventional Techniques REVIEW Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage

More information

MANAGEMENT OF COMPLICATED GALLSTONE DISEASE

MANAGEMENT OF COMPLICATED GALLSTONE DISEASE gastrointestinal tract and abdomen MANAGEMENT OF COMPLICATED GALLSTONE DISEASE Carmen L. Mueller, BSc(H), MD, FRCSC, Amy A. Neville, MD, FRCSC, MSc, and Gerald M. Fried, MD, FRCSC, FACS, FCAHS Gallstones

More information

Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis

Current status of laparoendoscopic rendezvous in the treatment of cholelithiasis with concomitant choledocholithiasis Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.4253/wjge.v7.i7.714 World J Gastrointest Endosc 2015 June 25; 7(7): 714-719 ISSN 1948-5190 (online)

More information

Evidence-based guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology

Evidence-based guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology Evidencebased guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology Trusted evidence. Informed decisions. Better health. Outline

More information

Open Common Bile Duct Exploration in a Nigerian Tertiary Hospital

Open Common Bile Duct Exploration in a Nigerian Tertiary Hospital ORIGINAL ARTICLE Open Common Bile Duct Exploration in a Nigerian Tertiary Hospital Adewale Adisa, Olusegun Alatise, Olalekan Olasehinde, Bolanle Ibitoye, Olukayode Arowolo, Oladejo Lawal Obafemi Awolowo

More information

During endoscopic retrograde cholangiopancreatography CLINICAL BILIARY

During endoscopic retrograde cholangiopancreatography CLINICAL BILIARY GASTROENTEROLOGY 2013;144:341 345 CLINICAL BILIARY Randomized Trial of Endoscopic Sphincterotomy With Balloon Dilation Versus Endoscopic Sphincterotomy Alone for Removal of Bile Duct Stones ANTHONY YUEN

More information

Is Endoscopic Retrograde Cholangiopancreatography Safe in Patients 90 Years of Age and Older?

Is Endoscopic Retrograde Cholangiopancreatography Safe in Patients 90 Years of Age and Older? Gut and Liver, Vol. 8, No. 5, September 2014, pp. 552-556 ORiginal Article Is Endoscopic Retrograde Cholangiopancreatography Safe in Patients 90 Years of Age and Older? Dae Young Yun, Jimin Han, Jang Seok

More information

Surgical versus endoscopic treatment of bile duct stones (Review)

Surgical versus endoscopic treatment of bile duct stones (Review) Surgical versus endoscopic treatment of bile duct stones (Review) Dasari BVM, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA This is a reprint of a Cochrane review, prepared and

More information

Department of General Surgery, Al Khor Hospital, Hamad Medical Corporation, Qatar 2

Department of General Surgery, Al Khor Hospital, Hamad Medical Corporation, Qatar 2 International Scholarly Research Network ISRN Minimally Invasive Surgery Volume 2012, Article ID 469013, 5 pages doi:10.5402/2012/469013 Clinical Study Laparoscopic Intraoperative Cholangiography Interpretation

More information

Title: The impact of a percutaneous cholecystostomy catheter in situ until the time of cholecystectomy on the development of recurrent acute

Title: The impact of a percutaneous cholecystostomy catheter in situ until the time of cholecystectomy on the development of recurrent acute Title: The impact of a percutaneous cholecystostomy catheter in situ until the time of cholecystectomy on the development of recurrent acute cholecystitis: a historical cohort study Authors: Mustafa Hasbahceci,

More information

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi Kelly Healy, Emory University Abbas Chamsuddin, Emory University James Spivey, Emory University Louis Martin,

More information

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 )

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Version 1.0 Page 1 of 3 Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Introduction Gallbladder is a sac connected to the biliary tree. It serves the function of concentration

More information

Laparoscopic Cholecystectomy in Patients With Previous Abdominal Surgery

Laparoscopic Cholecystectomy in Patients With Previous Abdominal Surgery SCIENTIFIC PAPER Laparoscopic Cholecystectomy in Patients With Previous Abdominal Surgery Nusret Akyurek, MD, Bülent Salman, MD, Oktay Irkorucu, MD, Öge Tascilar, MD, Osman Yuksel, MD, Mustafa Sare, MD,

More information

An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction

An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction Surg Endosc (2006) 20: 1594 1599 DOI: 10.1007/s00464-005-0656-x Ó Springer Science+Business Media, Inc. 2006 An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic

More information

EAST MULTICENTER STUDY PROPOSAL

EAST MULTICENTER STUDY PROPOSAL EAST MULTICENTER STUDY PROPOSAL (Proposal forms must be completed in its entirety, incomplete forms will not be considered) GENERAL INFORMATION Study Title: Prospective Multi-Institutional Evaluation of

More information

REFERRAL GUIDELINES: GALLSTONES

REFERRAL GUIDELINES: GALLSTONES REFERRAL GUIDELINES: GALLSTONES Document Purpose To ensure patients with gallstones disease are managed appropriately in primary/ secondary care Oxford Radcliffe Hospital Surgical Department Surgical Registrar

More information