Theadore Hufford, MD1, Andres Giovanetti, MD1, Charles Gruner, MD2. 1UIC/MGH General Surgery Residency, 2Presence St. Francis Hospital
INTRODUCTION: The approach to biliary disease has been traditionally treated with laparoscopic cholecystectomy (LC) in almost all settings but the approach to choledocholithiasis has not been so standardized. The use of pre-operative ERCP is common in most institutions, however the reliability of ERCP may place patients at a significant disadvantage as it requires an additional procedure and increased hospital stay. Traditional open exploration with cholecystectomy and common bile duct exploration (CBDE) allowed for definitive treatment in one operation. LC combined with intra-operative cholangiography (IOC) followed by laparoscopic common bile duct exploration (LCBDE) is also possible. This one stage approach requires the proper equipment and longer operative time, but decreases hospital length of stay (LOS), eliminates the need for another procedure, and decreases overall costs. Previous review of the experience at our community hospital from 1991-1997 was published in 1998. The objective of this study is to provide a follow up on this experience, 2011-2015.
METHODS: Retrospective chart review was done at a tertiary community hospital. The time frame utilized was 2011-2015. Information was obtained regarding the history and presentation, imaging studies, operative details and follow-up.
RESULTS: A total of 370 patients underwent LC from 2011 to 2015. 269 patients (72.7%) were female and 101 males (27.3%) underwent LC. The average age was 44 years and the ASA classification prior to surgery was ~1.25. Most were diagnosed with acute cholecystitis. Choledocholithiasis was revealed by IOC but was noted to resolve with simple flushing in ~60% of cases. 87% (44 patients) with CBD stones were successfully removed using a LCBDE technique. This technique was unsuccessful in 5.4% necessitating a post-operative ERCP. LCBDE patients initially remained in the hospital an average ~1.4 days longer while those that underwent ERCP followed by LC stayed ~3 days.
CONCLUSIONS: The management of choledocholithiasis with laparoscopy at the time of the initial procedure can be a safe alternative to the use of routine preoperative ERCP followed by definitive management, providing an optional therapy that can be done with one procedure. Our results show a high success rate, decreased length of stay and decreased costs using this approach. Lack of equipment, lack of experience with advanced laparoscopic techniques, and an increase in ERCP utilization are all likely contributing factors which prevent increased use of this technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80397
Program Number: P665
Presentation Session: Poster (Non CME)
Presentation Type: Poster