Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital
File Type:
PDFItem Type:
Journal ArticleDate:
2019Access:
openAccessCitation:
Memba, R., Gonz?lez, S., Coronado, D., (...), Conlon, K.C., Jorba, R., Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital, The Surgeon, 2019, 1--Abstract:
Background: Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment. Methods: A prospective cohort study of patients diagnosed with cholelithiasis and chol-edocholithiasis who were treated with the single-stage treatmentetranscystic instru-mentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) -between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate. Results: 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after “flushing” in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients(16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. Conclusions: Single-stage approach is a safe and effective management option forconcomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a trans-cystic approach, with presumable low morbidity and cost-efficiency.
Author's Homepage:
http://people.tcd.ie/conlonkhttp://people.tcd.ie/oconnd15
Description:
IN_PRESS
Author: Conlon, Kevin; O'Connor, Donal
Type of material:
Journal ArticleCollections
Series/Report no:
The SurgeonAvailability:
Full text availableKeywords:
Common bile duct stones, Choledocholithiasis, Single-stage treatment, One-step treatment, Transcystic approach, Choledochotomy, Concomitant choledocholithiasis, CholelithiasisDOI:
https://doi.org/10.1016/j.surge.2018.12.001Metadata
Show full item recordLicences: