Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration / 中华医学杂志(英文版)
Chinese Medical Journal
; (24): 3509-3513, 2012.
Article
in English
| WPRIM (Western Pacific)
| ID: wpr-256704
Responsible library:
WPRO
ABSTRACT
<p><b>BACKGROUND</b>Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones.</p><p><b>METHODS</b>From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3 ± 2.5) minutes, and the operative duration was (105.4 ± 23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (< 0.5 cm) and dilated cystic duct (> 0.3 cm), dilated common bile duct (> 0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7 ± 2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3 - 7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications.</p><p><b>CONCLUSIONS</b>Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.</p>
Full text:
Available
Database:
WPRIM (Western Pacific)
Main subject:
General Surgery
/
Diagnostic Imaging
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Cholangiography
/
Gallstones
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Cholecystectomy, Laparoscopic
/
Common Bile Duct
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Choledocholithiasis
/
Methods
Type of study:
Diagnostic study
/
Prognostic study
Limits:
Adolescent
/
Adult
/
Aged
/
Aged, 80 and over
/
Female
/
Humans
/
Male
Language:
English
Journal:
Chinese Medical Journal
Year:
2012
Document type:
Article