Leslie S Anewenah, MD1, Mohammed Asif, MD1, Andrea Zaw, MD1, Carissa Jeannette2, Urhum Khaliq2, Joseph Glowacki2, Shivani Shah2, Prashanth Ramachandra, MD1, Piotr Krecioch, MD1, Mohammad Khan, MD1. 1Mercy Catholic Medical Center, 2Philadelphia College of Osteopathic Medicine
Background: The widely accepted modalities for the management of choledocholelithiasis (CC) are: endoscopic retrograde cholangiopancreatography (ERCP) with cholecystectomy (Cty) and common bile duct exploration (CBDE) with cholecystectomy. Since the emergence of ERCP in the late 1970s, there has been an increasing use of ERCP in conjunction with Cty in the management of CC. The result is a new generation of general surgeons with little to no exposure in CBDE techniques.
Objective: The purpose of this study was to compare the clinical characteristics and outcomes of patients who presented with CC based on the treatment modality: ERCP-Cty or CBDE-Cty.
Methods: After obtaining approval from our institutional review board, a retrospective review was conducted on all patients who presented with CC from June of 2012 to May 2016. The data obtained include gender, age, American Society of Anesthesiologist score (ASA), body mass index (BMI), comorbidities, procedure time, length of stay (LOS) and complications within 30 days of surgery. The CBDE technique used in this series was an intraoperative cholangiogram. Independent T and Chi-square tests were performed using IBM® SPSS® 24 software.
Results: A total of 114 patients presented with CC. Of this number, ERCP-Cty was performed in 82 (72%) patients and the remainder treated with CBDE-Cty. Median age was 55 years (20 to 90 years) with 82 (72%) being female. There was no statistical difference in the median age and gender of the patients in both groups (Age: p = 0.22 and Gender: p = 0.65). BMI range from 15.8 to 57.2 kg\m2 (median of 29.9 kg\m2) and no difference noted among the two treatment arms (p=0.68). The median procedure time for performing ERCP-Cty was 131 minutes (46-385) compare to 168 minutes (68 to 372) for CBDE-Cty (p = 0.076). When patient characteristics such as ASA, diabetes, congestive heart failure, chronic obstructive pulmonary disease, chronic hepatitis, chronic kidney disease, anti-platelet or anticoagulation therapy and complications were noted, there was no difference between the two modalities. (p = 0.80, 0.30, 0.74, 1.00, 1.00, 0.31, 1.00, 1.00). Mean LOS was 6.43 days (0-27) for ERCP-Cty and 5.69 days (0-29) for CBDE-Cty (p = 0.53).
Conclusion: In addition to patients who undergo CBDE-Cty requiring only 1 anesthesia session as opposed 2 anesthesia sessions with ERCP-Cty, CBDE-Cty cut the LOS by 0.74 days. Our data suggest that CBDE-Cty remains a feasible modality for treating CC and therefore, should be employed more.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79235
Program Number: P630
Presentation Session: Poster (Non CME)
Presentation Type: Poster